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ADENOIDS  AND  DISEASED 
TONSILS 

THEIR  EFFECT  ON  GENERAL  INTELLIGENCE 


BY 

MARGARET  COBB  ROGERS,  Ph.D. 


ARCHIVES  OF  PSYCHOLOGY 

Edited  bt  R.  S.  WOODWORTH 

No.  50 


COLrHBIA  UmITEBSITT  CoNTBIBUnONS  TO  Phiix)8opht  akd  Psychologt 


NEW  YORK 
April,  1922 


AGENTS:     G.  E.  STECHERT  &  CO.  :   Lon 


St.,  W.  C);  Paris  (10,  rue 


CONTENTS 
Introduction 

Purpose  of  the  Study.  5 

Chapter  I.  7 

Previous  Literature  Concerning  the  Relation  of  Nose  and 
Throat  Defects  to  Intelligence. 

Chapter  II.  24 

Method  and  Procedure. 

1.  A  Statistical  Study. 

2.  A  Study  of  Improvement  After  Treatment. 
Selection  of  Cases. 

The  Tests. 

Charter  III.  29 

Discussion  of  the  Results. 

1.  The  Statistical  Study. 

2.  The  Study  of  Improvement  after  Operation. 

Chapter  IV.  53 

Measurement  of  Improvement  after  a  Second  Interval  of 
Six  Months. 

Chapter  V.  68 

Summary. 
Conclusions. 


INTRODUCTION— PURPOSE 

DURING  the  last  decade  or  two  there  has  been  a  growing 
interest  among  physicians  in  defects  of  the  nose  and 
throat.  This  interest  has  centered  in  part  upon  those 
two  afflictions  of  childhood — adenoids  and  diseased  tonsils, — 
or  even  tonsils  that  are  merely  enlarged.  There  is  no  doubt 
of  the  physical  handicap  borne  by  a  child  who  is  possessed  of 
them.  As  a  seat  of  inflammation,  a  source  of  infection,  a 
hindrance  to  proper  breathing, — in  a  multitude  of  ways  they 
have  seemed  to  deserve  the  verdict, — "Have  them  out."  Many 
physicians,  to  be  sure,  have  cautioned  against  the  wholesale 
removal  of  tonsils,  saying  that  tonsils  which  are  large  in  early 
childhood  very  commonly  are  absorbed  at  an  early  age. 

But  it  is  not  my  purpose  to  discuss  the  question  of  the 
efficacy  of  removing  adenoids  and  tonsils.  The  aim  of  this 
study  is,  rather,  to  determine  experimentally  whether  or  not 
there  exists  any  causal  relation  between  defect  in  this  respect 
and  lowering  of  intelligence  level.  One  hears  statements 
made  both  pro  and  con  by  physicians  and  laymen,  but  there 
has  been  little  experimental  proof.  It  would  seem  to  be  rather 
useful  for  a  physician  to  know  in  advance  with  how  much 
probability  of  correctness  he  is  speaking,  when  he  advises 
a  mother  that  the  removal  of  adenoids  and  tonsils  from  the 
throat  of  her  backward  child  will  make  him  "bright."  The 
question  in  the  present  case,  however,  is  broader  than  that 
of  relation  between  these  afflictions  and  mental  defect.  We 
are  inquiring  not  merely  whether  adenoids  and  tonsils  are 
causes  of  subnormality  or  dullness,  but  also  whether  they  tend 
to  lower  the  intelligence  quotient  in  general  however  high  it 
may  be.  Would  the  mentally  normal  child  with  adenoids  and 
tonsils  have  been  superior  without  them,  and  would  the  su- 
perior child  have  been  still  more  superior?  What  is  the  re- 
lation between  adenoids  and  tonsils,  and  intelligence? 

The  method  employed  in  the  present  experiment  would 
seem  to  give  it  value  from  the  point  of  view  of  the  clinical 
psychologist.  With  the  present  emphasis  upon  exactitude  in 
mental  testing,  investigators  have  become  interested  in  prob- 


lem  of  the  constancy  of  the  I.  Q.  Adenoids  and  abnormal  ton- 
sils have  been  suggested  as  possible  factors  affecting  this  con- 
stancy. The  results  of  the  experiment  should  throw  some 
light  on  the  question. 

It  should  be  understood  that  this  study  is  concerned  with 
general  intelligence,  and  not  with  the  child's  efficiency  as  a 
member  of  society.  The  latter  question  is  much  broader  than 
the  one  we  are  investigating.  It  includes  not  only  intelligence, 
but  physical  state,  emotional  make-up,  volition:  in  short,  the 
personality  as  a  whole.  Success  in  school  work  for  example, 
depends  upon  all  of  these  factors.  For  that  reason,  the  re- 
sults to  be  reported  here,  cannot  be  interpreted  as  applying 
to  this  broader  conception.  We  cannot  say  at  the  end  whether 
or  not  the  physical  defects  under  consideration  affect  the 
child's  success  as  a  member  of  society.  We  hope  to  be  able, 
however,  to  determine  their  effect  upon  one  element  of  that 
success,  namely  intelligence. 

In  presenting  the  results  of  this  experiment,  the  writer 
is  especially  indebted  to  Professor  R.  S.  Woodworth,  under 
whose  auspices  the  investigation  was  carried  out,  for  his 
interest  and  advice;  and  to  Dr.  Leta  S.  Hollingworth  for  the 
suggestion  of  the  problem,  practical  aid  in  obtaining  subjects, 
and  constant  inspiration.  She  is  indebted  to  the  School  of 
Education,  Teachers'  College,  for  the  provision  of  operative 
treatment  for  the  subjects;  to  Mr.  Mark  and  his  officers  at 
Public  School  64 ;  and  to  Superintendent  O'Brien  of  the  Man- 
hattan Eye,  Ear  and  Throat  Hospital.  It  must  be  said  that 
by  their  hearty  and  generous  cooperation  they  have  con- 
tributed in  a  large  measure  to  whatever  value  this  study  may 
possess. 


ADENOIDS  AND  DISEASED  TONSILS; 

THEIR  EFFECT  UPON  GENERAL 
INTELLIGENCE 


CHAPTER  I. 

PREVIOUS  LITERATURE 

Concerning  the  Relation  of  Nose  and  Throat  Defects  to 

Intelligence 

There  are  very  few  experimental  studies  of  the  relation 
between  intelligence  and  the  two  defects  considered  here. 
There  are  a  few  statistical  studies,  and  among  earlier  writers 
especially  many  statements  of  opinion  on  the  matter.  Char- 
acteristic of  the  latter  is  the  following  extract  from  an  article 
in  the  Boston  Medical  and  Surgical  Journal,  March,  1886.* 

" .  .  .  it  is  a  fact  that  their  intelligence  may  become  weak- 
ened and  their  characters  changed.  They  do  not  progress  in 
their  studies  at  school,  are  generally  at  the  bottom  of  the  class 
and  remain  in  it  longer  than  the  prescribed  time ....  That  the 
impairment  of  intellect  and  want  of  energy  manifested  by 
these  children  is  real,  and  not  merely  in  the  expression  of 
countenance,  is  made  evident  by  watching  these  same  children 
after  the  growths  have  been  removed.  To  the  gratification 
and  astonishment  of  the  parents  and  teachers,  the  children 
hitherto  sluggish  and  dull  of  comprehension,  now  make  rap- 
id progress,  and  their  comrades  soon  cease  to  make  a  laughing 
stock  of  them." 

The  following  quotation  from  an  article  by  Irving  Town- 
send,  M.  D.,  is  in  the  same  vein  if 

"Aprosexia  is  the  rather  imposing  term  applied  to  the  im- 
perfect or  arrested  mental  development  attributed  to  this 


*F.  Hooper,  M.  D.,  quoting  from  a  paper  by  B.  Frankel. 
tAdenoid  Growths  of  the  Naso-pharynx.     Read  before   the   Homeo- 
pathic Medical  Society  of  New  York,  February,  1895. 


8  ADENOIDS  AND  DISEASED  TONSILS: 

eondition.  This  is  denied  by  some  authors,  who  claim  that 
the  dullness  of  comprehension  and  inattention  are  only  ap- 
parent, and  due  only  to  defective  hearing.  A  strong  evidence 
of  its  reality  lies  in  the  fact  that  these  children  show  most 
marvelous  intellectual  development  after  the  removal  of  the 
growth,  even  in  cases  where  deafness  is  not  markedly  im- 
proved." 

A  most  enthusiastic  denouncer  of  adenoids  and  abnormal 
tonsils  is  H.  Addington  Bruce.  Concerning  their  direful  ef- 
fects upon  the  intelligence,  and  the  magical  results  of  their 
removal,  he  is  continually  reiterating:* 

"Often  a  surprising  development  of  both  mental  and 
physical  power  follows  the  removal  of  adenoids.  In  one  case 
reported  by  Professor  Swift,  a  girl  of  fourteen  grew  three 
inches  within  six  months  after  an  operation  for  ade- 
noids, and  at  the  same  time  showed  an  improvement  in  her 
school  work  that  contrasted  strikingly  with  the  dullness  that 
preceded  it.  Another,  three  years  younger,  grew  six  inches  in 
about  five  months,  and  from  being  a  sad  idler  was  transformed 
into  an  unexpectedly  attractive  and  bright  pupil.  A  boy  of 
twelve,  backward  both  mentally  and  physically,  likewise  lost 
his  dullness  and  laziness  within  an  astonishingly  short  time 
after  the  impediment  had  been  removed." 

And  again: 

"The  boy  or  girl  suffering  from  adenoidsf  is  usually  a 
mouth-breather  because  of  the  difficulty  experienced  in 
breathing  through  the  nose.  But  mouth-breathing  means  dif- 
ficult breathing,  and  this  in  turn  means  deficient  oxidation 
of  the  tissues,  with  a  resultant  lowering  of  vital  activities 
generally  and  of  the  activity  of  the  brain  in  particular.  Ac- 
cordingly, the  psychologist  of  today  insists  that  every  adenoid- 
afflicted  child  should  be  given  prompt  medical  attention,  with 
a  view  to  correcting  the  vicious  mouth-breathing  habit,  and 
thus  aiding  the  child  to  gain  a  fair  start  in  the  development 
of  mental  and  physical  health." 

The  following  extracts  are  quoted  from  Burgerstein's 
"Handbuch  der  Schulhygiene" : 

"Bresgen  und  Heymann  machen  endlich  darauf  aufmerk- 
sam,  dass  die  Ursache  der  Kephalalgie  haufig  in  der  Behin- 


*H.  Addington  Bruce,  Psychology  and  Parenthood,  1916. 
fH.  Addington  Bruce  in  the  Century  Magazine,  1916 — The  Mind  of 
the  Child. 


THEIR  EFFECT  UPON  GENERAL  INTELLIGENCE  9 

derung  der  Nasenatmung  zu  suchen  ist,  als  Folgerscheinung 
von  Verengerung  der  Nase  bei  ingen  Baue  des  Knochengerus- 
tes,  Knochenkaries  und  Geschwulsten,  Schwelungen  der 
Scheimhaute,  akuten  Schnupfen,  Verstofungen  der  Highmor- 
shohle,  Vergrosserung  der  Mandeln  u.  s.  w." 

"Viele  Kinder  erscheinen  schwachbegabt,  ohne  os  zu  sein, 
da  bei  denselben  entweder  nach  behebung  von  Ohrenkrank- 
heiten,  nach  Herstellung  der  freien  atmung  oder  Gebrauch 
einer  entsprechenden  Brille  die  scheinbare  Geistesschwache 
schwindet."* 

Quotations  like  these,  and  equally  unsupported  by  experi- 
mental evidence,  might  be  multiplied  indefinitely,  especially 
if  we  look  into  the  literature  of  a  dozen  years  ago.  Since  they 
can  have  little  authoritative  value,  I  shall  limit  myself  to  two 
more  specimens,  one  taken  from  the  Psychological  Clinic, 
1916.t 

"But  when  these  physical  defects  (poor  eyesight,  defective 
hearing,  adenoids,  bad  tonsils,  etc.)  are  corrected  so  that  the 
mind  can  function  without  any  outcry  from  the  physical  body, 
these  children  recuperate  mentally  and  often  make  greater 
progress  than  the  so-called  normal  children  in  the  regular 
grades." 

The  second  is  a  quotation  from  Jelliffe  and  White,  "Dis- 
eases of  the  Nervous  System."  Lee  and  Ferbiger,  1917,  p.  903. 

"An  important  group  (of  mental  defects)  is  due  to  ade- 
noid vegetations  in  the  posterior  pharynx.  Under  such  con- 
ditions of  ill  health,  development  is  impaired  and  does  not  pro- 
ceed at  a  normal  rate.    With infected  tonsils,  which 

produce  a  constant  toxemia,  the  child  cannot  be  expected  to 
proceed  in  his  development  with  normal  rapidity." 

In  the  medical  and  psychological  literature  of  the  last  few 
years,  along  with  the  growth  of  general  discussion  into  the 
various  phases  of  the  operation  itself,  we  find  a  general  dis- 
inclination to  take  on  faith  the  magic  effect  of  adenectomy 
and  tonsillectomy.  This  growth  of  critical  spirit  has  shown 
itself  in  statistical  investigations,  and  in  studies  of  pedagogi- 
cal and  mental  improvement  after  operation. 

The  statistical  studies  of  physical  defects  in  the  schools 
reveal   almost   universally   a  positive   relationship   between 

*The  italics  are  mine. 

tPsych.  Clinic,  1916,  10,  45-48.     Anna  Johnson.     The  Teacher  in  the 
Retarded  School. 


10  ADENOIDS  AND  DISEASED  TONSILS: 

school  retardation  and  possession  of  adenoids  and  diseased 
tonsils.  One  of  these  was  conducted  by  Ayres  for  the  Back- 
ward Children  Investigation  of  the  Russell  Sage  Foundation 
in  New  York  City.*  The  investigators  examined  the  school 
records  of  20,000  children  from  fifteen  schools  in  Manhattan. 
Eight  thousand  of  these  had  been  examined  by  school  physi- 
cians. The  records  of  the  physical  examinations  showed  that 
80  per  cent  of  the  children  who  were  normal  for  their  grade 
had  physical  defects  while  only  about  75  per  cent  of  the  re- 
tarded children  were  physically  defective. 

This  astonishing  result  was  found  upon  retabulation  of 
the  data  by  ages,  to  be  due  to  the  fact  that  for  each  defect 
there  is  a  gradual  falling  off  in  frequency  from  the  age  of  six 
up  to  fifteen — eye-defect,  only,  excepted.  Since  the  retarded 
children  in  each  grade  will  be  the  older  children  in  that  grade, 
and  since  older  children  have  fewer  defects,  the  retarded  chil- 
dren will  show  a  smaller  proportion  of  defect. 

To  overcome  this  difficulty,  Ayres  used  an  age  basis  in- 
stead of  a  grade  basis  in  interpreting  his  results.  Records  of 
all  the  children  at  the  ages  of  10, 12, 13,  and  14  were  retabulat- 
ed,  a  group  of  3304  children,  and  rated  as  dull,  normal  or 
bright  according  to  the  grade  in  which  they  were  found.  The 
results  were  worked  out  in  percentages  of  a  group,  and  are 
shown  in  the  following  tables : 

Dull     Normal       Bright 

Number  of  children  examined    407  2588  309 

Defects  per  child    1.65  1.30  1.07 

Enlarged  glands     20  13  6 

Defective  vision    24  25  29 

Defective   breathing     15  11  9 

Defective  teeth    42  40  34 

Hypertrophied   tonsils     26  19  12 

Adenoids     15  10               6 

Other  Defects    21  11  11 

Defective       75  73  68 

Not  defective     25  27  32 

Average  number  of  grades  completed  by  pupils  having  no 
physical  defects,  compared  with  the  number  completed  by 
those  suffering  from  different  defects : 

♦Psych.  Clinic,  1909,  3,  71-77.  The  Effect  of  Physical  Defect  on  School 
Progress. 


THEIR  EFFECT  UPON  GENERAL  INTELLIGENCE  11 

3304  Children,  10-14  years,  grades  1-8 

Average  grades 

completed  %  lost 

Children  having  no  physical  defects  4.94 

Children  having  enlarged  glands  4.20  14.9 

Children  having  defective  vision 4.94  0 

Children  having  defective  breathing 4.58  7.2 

Children  having  defective  teeth  4.65  5.9 

Children  having  hypertrophied  tonsils  4-50  8.9 

Children  having  adenoids 4.24.  H.1 

Children  having  other  defects 4.52  8.5 

Cornell  reports  several  investigations  in  the  Psychological 
Clinic,  January  and  May,  1908.  Three  of  these,  in  which 
children  were  rated  on  the  basis  of  grades  received  in  school 
work,  are  here  combined  to  show  the  grades  of  normal  chil- 
dren, "average"  children,  generally  defective  children,  those 
possessing  adenoids  and  tonsils,  and  the  deaf. 


Deaf 


General 

Adenoids 

No.  of  cases    Normal 

Average 

Defective 

and  Tonsils 

Adenoids 

Allison 

219 

9th  St             64 

84 

21 

8 

Claghorn      179 

252 

13 

Grade  in  language 

9th   St.            72.9 

70.5 

63.3 

60 

Claghorn        74.4 

72.7 

71.4 

Grade  in  Arith. 

9th  St.             75.5 

74 

70 

66.7 

Claghorn        72 

70 

65.1 

Grade  in  spelling 

9th  St.            75.4 

72.8 

64.8 

65 

Grade  in  geography 

Claghorn        76.6 

76.5 

76.2 

Average  of  grades 

Allison            75 

74 

72.6 

72 

9th   St.            74.6 

72.4 

66 

63.9 

Claghorn        74.3 

73.1 

70.8 

67 


An  additional  investigation  of  four  classes  in  the  same 
grammar  grade  of  the  Claghorn  School  gives  the  following 
results : 

Class  1     Class  15     Class  9     Class  11 

Number  of  children 

Normal     

Defective     

Percentage   of   normal    

In  the  same  article.  Dr.  Cornell  gives  the  results  of  another 
study  of  Philadelphia  schools,  made  in  1906.  The  study  com- 
prised a  comparison  of  children  exempt  from  examinations 


Bright  Children 

Dull 

Dullest 

50             39 

32 

29 

36             32 

20 

13 

14               7 

12 

16 

72             82 

62.5 

44.8 

56 

28 

39 

38 

87 

35 

75 

34 

128 

65 

81 

49 

183 

71 

103 

75 

193 

61 

127 

66 

647 

260 

425 

262 

28.8 

38.1 

12  ADENOIDS  AND  DISEASED  TONSILS: 

on  account  of  high  standing,  with  those  not  exempt.    The  re- 
sults follow: 

Exempt  Children      Non-exempt  Children 
Normal     Defective      Normal     Defective 

9th  St.  Primary   

Rutledge  School    

Allison    School    

Camac   School    

Claghorn    School    

Percentage   Defective 

When  the  four  classes  of  bright  and  dull  children  were  ex- 
amined again,  and  the  different  sorts  of  defects  compared  for 
the  groups,  enlarged  tonsils,  adenoids,  deafness,  and  nasal 
catarrh,  were  found  to  occur  much  more  frequently  among 
the  two  classes  of  duller  children. 

Class  1     Class  15     Class  9     Class  11 
Bright  Children       Dull       Dullest 

Number  of  children    50  39              32  29 

Nose  and  throat  conditions, 

number  defective   6  4                9  9 

Tonsils    3  U                 S  3 

Adenoids    2  1                 5  6 

Deaf   2  5  1 

Catarrh    2  3 

Percentage  of  children, 

nose  and  throat  defects  . .  12  10.2           28.1  31 

During  the  same  year,  another  examination  along  the 
same  lines  was  conducted  in  the  William  McKinley  Primary 
School,*  where  a  large  number  of  dull  children  had  been 
grouped  in  special  classes. 

None  of  these  children  were  mentally  defective,  says  Dr. 
Cornell,  and  only  a  few  were  really  backward.  The  proportion 
of  physical  defect  was  found  to  be  very  large, — in  174  pupils, 
188  physical  defects  (68  eye-strain,  40  nasal  obstruction,  80 
miscellaneous,  11  hypertrophied  tonsils.)  In  a  special  class  at 
the  Wharton  school,  numbering  22  children,  14  of  the  children 
suffered  from  adenoids,  associated  in  3  cases  with  enlarged 
tonsils.  Since  no  comparison  is  made  with  normal  classes, 
this  survey  cannot  be  regarded  as  conclusive. 

Wallin,  in  his  book,  "Mental  Health  of  the  School  Child," 
discusses  several  other  investigations  of  the  relation  of  in- 
telligence to  physical  defect.    Only  those  studies  in  which  were 


♦Cornell,  Psychological  Clinic,  2,  1909. 


THEIR  EFFECT  UPON  GENERAL  INTELLIGENCE  IZ 

included  adenoids  and  tonsil  conditions  will  be  reviewed  here. 
Those  by  Ayres  and  Cornell  have  been  described  above. 

In  Elmira,  New  York,  says  Wallin,  "an  investigation  of 
repeaters  in  the  second  grade  showed  that  21  per  cent  of 
those  who  required  three  years  and  40  per  cent  of  those  who 
required  four  years  to  complete  the  grade  had  adenoids,  as 
against  only  19  per  cent  of  those  who  required  only  two  years 
to  do  the  grade." 

Another  study  described  by  Dr.  Wallin  was  made  by  Heil- 
man  in  1907  of  1000  Camden  repeaters.  The  correlation  be- 
tween pedagogical  retardation  and  percentage  of  defect  in 
each  group  was  as  follows : 


Defects 

Retardation 

lyr. 

2yr, 

3yr. 
Per  Cent 

4yr. 

5yr. 

Health 

16.5 

21.3 

28.0 

19.0 

37.5 

Nutrition 

13.4 

8.9 

17.2 

20.2 

17.5 

Adenoids 

6.2 

7.3 

8.1 

9.6 

7.5 

Speech 

5.2 

5.1 

4.2 

10.5 

20.0 

Visual  defects 

15.5 

15.9 

18.2 

22.8 

22.8 

Auditory 

8.2 

6.7 

4.9 

6.1 

10.0 

Burpitt*  describes  an  investigation  of  400  children,  200 
male  and  200  female,  considered  by  their  teachers  to  be  "dull 
and  backward,  but  not  to  fall  within  the  meaning  of  feeble- 
mindedness as  given  in  the  Mental  Deficiency  Act  of  1913." 
The  children  were  examined  for  physical  defects  and  other  ab- 
normal conditions.  The  author  says  that  in  36  per  cent  of 
the  cases,  the  cause  for  backwardness  was  found  to  be  "inher- 
ent dullness."  (The  basis  for  judgment  of  inherent  dullness 
is  not  given.)  Adenoids  and  tonsillar  tissue  were  found  in 
18.75  per  cent  of  the  cases,  and  were  "more  prevalent  than 
among  the  children  of  the  area  as  a  whole." 

The  degree  of  retardation,  based  upon  the  number  of 
school  standards  below  normal,  was  ascertained  for  pupils 
who  suffered  from  various  defects.  The  relative  retardation 
was  expressed  by  the  fraction  j^  where  n  =  number  of 
years  retarded,  and  A  =  age.  Eighteen  per  cent  of  the  chil- 
dren were  so  retarded  that  the  fraction  was  greater  than  3-9. 


*H.  R.  Burpitt.     Relative  Degrees  of  Dulness  and  Backwardness  in 
School  Children  and  their  Causation.   Journal  of  Mental  Science,  1916. 


14  ADENOIDS  AND  DISEASED  TONSILS: 

These  were  divided  into  two  groups, — 3-9  to  4-9  and  4-9  to 
5-9.    The  results  are  given  in  the  following  table : 

Causes  46  children  24  children 

3-9  to  4-9  4-9  to  5-9 

Inherent  dullness  only    8  3 

Inherent  dullness  and  one  or  more  physical 

defects       7  2 

Irregular    attendance    with    one    or    more 

physical  defects    9  6 

Irregular  attendance     2  3 

Adenoids   only     2  0 

Turning  to  what  the  author  calls  single  causes, — present 
in  170  cases  out  of  the  400, — 

Causes  151  children       19  children 

1-9  to  3-9  3-9  to  6-9 

Irregular  attendance     51  6 

Adenoids     2^  2 

Inherent   dullness     59  11 

The  term  "cause"  seems  to  be  rather  loosely  used  in  this 
study.    The  author  says  concerning  this, 

"Dealing  with  physical  defects  first,  although  they  amount 
in  the  aggregate  to  53  per  cent  (omitting  defective  speech, 
which  is  a  secondary  condition),  in  10  percent  only  do  they 
represent  the  whole  cause.  This  is  made  up  of  those  cases 
where  the  defect  is  of  such  intensity  as  to  produce  retardation 
in  otherwise  ordinary  children,  and  of  other  cases  of  less  in- 
tensity, but  sufficient  to  weigh  down  the  balance  against  those 
near  the  level  of  what  we  may  call  for  convenience  the  lower 
limit  of  normal  intelligence."  How  he  determines,  without 
removing  a  defect,  what  the  child's  intelligence  would  be  with- 
out it  he  does  not  explain. 

The  following  table  compares  the  physical  condition  of  two 
groups,  one  comprised  of  children  examined  in  the  regular 
routine  examinations  during  the  year  1912, — the  other  a 
group  of  retarded  school  children,  given  a  special  examina- 
tion : — * 


No. 
No. 
No. 

of  children  examined 
with  physical  defects 
of  defects  found 

Group  I 

287,456 

206,720—71.9% 

226,639 

Group  II 
1,541 

1,383—89.8% 
2,986 

♦Transactions  of  the  International  Congress  on  School  Hygiene,  1913, 
The  Physical  Condition  of  Retarded  School  Children. 


THEIR  EFFECT  UPON  GENERAL  INTELLIGENCE  15 


Defect 

No. 

% 

No. 

% 

Anaemia 

335 

23 

Malnutrition 

8,303 

2.9 

557 

36.1 

Defective  vision 

21,078 

9.3 

536 

34.7 

Defective  hearing 

1,206 

0.5 

47 

3 

Defective  nasal  breathing 

21,931 

7.6 

SI  6 

20.U 

Hypertrophied  tonsils 

80,021 

10. i. 

297 

19.2 

Defective  teeth 

142,168 

49.4 

796 

51.6 

Pulmonary  disease 

335 

0.1 

47 

3.0 

Cardiac  disease 

1,597 

0.5 

35 

2? 

Average  No.  of  defects  per  child  1.1  2.5 

In  an  investigation  of  3,587  exempt  and  1,418  non-exempt 
children  in  the  Philadelphia  schools,*  Dr.  Newmayer  found 
the  following  percentages  of  defect: 


Exempt  Children 

Non-exempt  Children 

Defect 

No.  Examined 

% 

No. 

Examined 

% 

Defective   vision 

371 

10.0 

171 

12.0 

Defective  hearing 

49 

1.4 

29 

2.0 

Defects  of  nose 

54 

1.5 

21 

1.5 

Defects  of  throat 

1S7 

3.8 

53 

S.7 

Orthopedic  defects 

25 

.7 

25 

1.8 

Mentally  defective 

6 

.1 

80 

5.6 

Skin  diseases 

918 

26.0 

423 

30.0 

Miscellaneous 

214 

6.0 

128 

9.0 

Total 

1,774 

49.0 

930 

65.0 

It  is  evident  from  the  majority  of  these  investigations 
that  there  is  some  relationship  between  physical  defects  and 
pedagogical  retardation.  But  whether  or  not  the  relationship 
is  a  causal  one,  they  do  not  indicate.  Simple  co-existence  of 
two  characteristics  is  not  necessarily  significant  that  one  is 
cause  of  the  other.  Plainly,  though,  if  the  removal  of  a  phy- 
sical defect  is  followed  by  improvement  in  the  school  progress, 
it  may  be  argued  that  the  presence  of  the  defect  was  a  causal 
factor  in  the  previous  retardation.  The  method  in  the  few  fol- 
lowing studies,  which  seems  to  be  employed  to  a  greater  de- 
gree than  formerly,  consists  of  measurement  of  such  improve- 
ment. 

The  Journal  of  Psycho-Asthenics,  March  and  June,  1918, 
contains  a  paper  on  the  "Results  obtained  from  the  Removal 
of  Tonsils  and  Adenoids  in  the  Feebleminded,"  by  Wm.  J.  G. 
Dawson,  M.  D.  The  author  starts  out  rather  discouragingly 
by  regarding  his  hypothesis  as  an  axiom.    He  says, 

"It  is  a  well-known  fact  that  hypertrophy  of  the  tonsils 
and  presence  of  adenoids  may  produce  more  or  less  dullness 


"Ayres:  "Laggards  in  Our  Schools."  1909. 


16 


ADENOIDS  AND  DISEASED  TONSILS: 


of  the  intellect  in  normal  children.  This  is  a  result  of  the  im- 
perfect aeration  of  the  blood  which  supplies  the  brain,  on  ac- 
count of  obstruction  to  respiration.  In  the  feebleminded, 
conditions  are  more  or  less  similar." 

One  hundred  and  twelve  cases  in  the  Sonoma  State  Home, 
Eldridge,  California,  were  operated  on.  Of  these  6  are  re- 
corded as  borderline,  39  as  morons,  50  as  imbeciles,  and  17  as, 
idiots.  Adenoids  were  always  removed  when  they  were  pres-^ 
ent.    The  results  of  the  operation  are  as  follows : 


Mouthbreathing 

Eneuresis 

Sore  throats 

Ear  trouble 

Change  in  voice 

Tonsillar  tissue  recurred  in 

General  physical  health 


Mental  improvement  from  observation 


Number 

Number 

before 

after 

Operation 

Operation 

43 

31 

33 

32 

70 

2 

19 

2 

38  improved 

5 

90  improved 

6  borderlines 

33  morons 

42   imbeciles 

9  idiots 

27   improved 

4  borderlines 

15  morons 

7  imbeciles 

1  idiot 

The  inaccuracy  of  this  investigation  is  evident.  The  mental 
improvement  was  measured  by  "observation,"  which  is  at  best 
inexact,  and  susceptible  to  the  influence  of  any  expectation  of 
improvement  on  the  part  of  the  observer.  The  degree  of  im- 
provement is  not  mentioned,  nor  is  the  time  interval  allowed 
for  the  appearance  of  such  improvement.  There  is  no  con- 
trol group,  and  consequently,  no  way  of  knowing  whether  the 
improvement  was  due  to  the  removal  of  the  defect. 

A  similar,  though  rather  more  careful  study  is  reported  by 
Dr.  Charles  James  Bloom  in  the  New  Orleans  Medical  and 
Surgical  Journal  for  April,  1917.  Dr.  Bloom's  experiment 
consisted  of  eighteen  months'  observation  on  the  mental  and 
physical  state  following  the  removal  of  adenoids  and  tonsils 
from  one  hundred  and  fourteen  children.  This  number  was 
later  reduced  to  fifty-seven,  because  of  the  fact  that  a  number 
failed  to  return.  There  was  no  selection,  all  the  patients  be- 
^ns  taken  as  admitted. 


THEIR  EFFECT  UPON  GENERAL  INTELLIGENCE  17 

The  patient's  physical  and  mental  state  was  recorded  at 
the  time  of  admission.  School  reports  were  used  as  an  index 
of  intelligence.  From  this  time  on  the  patients  were  exam- 
ined, weighed  and  measured  at  monthly  intervals. 

The  ages  of  the  children  ranged  from  four  to  fourteen 
years,  inclusive.  Thirty-five  per  cent  were  under  six  years, 
and  sixty-five  per  cent,  therefore,  over  six.  Twenty-nine  were 
boys,  twenty-eight  girls. 

Omitting  a  part  of  the  study  which  though  interesting  has 
no  bearing  upon  our  problem,  we  turn  to  results  in  the  way  of 
mental  status.  There  were  fifty-seven  cases,  ten  of  whom 
were  under  the  school  limit.  Of  the  remaining  forty- 
seven,  seven  sent  in  no  report.  In  four,  or  ten  percent  of  the 
forty  remaining,  there  was  no  progress.  In  thirty-six,  or 
ninety  per  cent,  appreciable  progress  was  reported.  One  of 
the  four  unimproved  cases  was  syphilitic,  the  other,  the  au- 
thor saj'^s  was  a  moron. 

Quotation  of  the  teachers'  reports  will  be  of  interest. 

"  'Some  improvement.'  'Better  work  than  previous  year.' 
'More  effort  displayed.'  'Improved  wonderfully.'  'Improve- 
ment first  term,  not  so  much  second.'  'Before  removal,  not 
transferred;  after  removal  transferred.'  'Very  much  im- 
proved, both  mentally  and  physically.'  'Has  made  progress.' 
'Remarkable  improvement.'  'Not  transferred  before  removal, 
but  after.'  'More  attentive.'  'A  very  small  but  gradual  im- 
provement.' 'Am  happy  to  tell  you  that  he  is  studying  more 
since  tonsils  and  adenoids  were  removed.'  'Greatly  improved.' 
'Attention  better.'    'More  concentration.'  " 

In  this  experiment  like  the  preceding,  the  judges  are  liable 
to  the  effect  of  expectation  of  improvement.  Although  the  re- 
ports are  more  explicit,  they  are  still  couched  in  general  terms, 
and  not  commensurable.  Some  reports  refer  to  intelligence 
and  some  to  pedagogical  standing.    There  is  no  control  group. 

On  the  basis  of  these  results,  the  author  concludes : 

"Children  exhibiting  some  alternatives  in  the  normal  his- 
tology of  tonsils  and  adenoids,  give  marked  evidences  of  men- 
tal impairment."  This  seems  to  be  a  rather  sweeping  state- 
ment in  consideration  of  the  number  of  intellectually  superior 
children  who  suffer  from  adenoids  and  diseased  tonsils. 

Another  investigation  was  made  by  Dr.  Cornell  in  the  Phil- 


18  ADENOIDS  AND  DISEASED  TONSILS: 

adelphia  schools,*  where  seventy  more  or  less  retarded  pupils 
in  grades  one  to  four  were  operated  on  for  adenoids.  Accord- 
ing to  the  teachers'  reports — 

30  per  cent  improved  considerably. 
40  per  cent  improved. 
25  per  cent  did  not  improve. 
1.6  per  cent  deteriorated. 
3.0  per  cent  deteriorated  considerably. 
Of  those  who  had  two  chances  of  promotion, 
6.3  per  cent  were  promoted  twice. 
16.0  per  cent  failed  twice. 
33.3  per  cent  were  promoted  once. 
33.3  per  cent  failed  once. 
With  one  opportunity, 
11.0  per  cent  were  promoted. 
31.7  per  cent  failed. 

"The  promotion  record  was  thus  decidedly  poor.  It  is 
possible,  however,  that  the  time  for  promotion  came  before 
the  orthogenic  effects  of  the  operations  had  become  effective." 

The  same  criticisms  may  be  brought  against  this  investi- 
gation as  were  mentioned  in  connection  with  the  preceding 
ones.  Teachers'  estimates  of  improvement,  especially  when 
such  improvement  is  expected,  and  without  means  of  measur- 
ing it  objectively,  are  necessarily  inaccurate.  Again  there 
is  no  control  group.  Of  even  less  value  are  the  results  of  an 
investigation  in  New  York  City  by  Cronin,  where,  out  of 
eighty-seven  cases  operated  on  for  enlarged  tonsils  and  ade- 
noids, "many  advanced  three  grades  during  the  rest  of  the 
school  year,  and  only  three  lost  time." 

An  interesting  study  is  one  that  is  described  by  John  C. 
Simpson,  M.  D.,  in  the  Journal  of  the  American  Medical  As- 
sociation, April  1,  1916. 

Dr.  Simpson's  results  are  based  on  a  study  of  571  boys  of 
Girard  College  who  had  been  operated  on  for  adenoids  and  ton- 
sils. Improvement  was  studied  along  several  different  lines, 
among  them  scholastic  ability.  For  this  part  of  the  study,  45 
were  chosen  alphabetically,  3  from  each  section.  The  only  selec- 
tion was  for  boys  who  were  operated  on  long  enough  after  com- 
ing to  school  to  give  an  idea  of  scholastic  ability;  and  long 
enough  before  the  present  study  to  permit  a  judgment  as  to 


*V/allm:  "Mental  Health  of  the  School  Child."  1914. 


THEIR  EFFECT  UPON  GENERAL  INTELLIGENCE  19 

their  improvement.  Monthly  averages  were  taken  of  each  boy 
up  to  the  time  of  the  operation  and  from  then  to  the  time  of 
this  study.  They  were  based  on  an  average  of  100  per  cent.  As  a 
control  group,  there  were  chosen  45  boys  who  had  had  no 
operation,  and  who  lived  and  worked  under  the  same  condi- 
tions. They  also  were  taken  alphabetically,  3  from  each 
section. 

The  general  average  of  the  operative  cases  at  the  first 
measurement  was  74.04.  Of  these  25,  or  55.5  per  cent  gave  an 
average  increase  in  monthly  standing  of  4.45  after  operation, 
while  the  remaining  20,  or  44.5  per  cent  suffered  a  decrease 
of  6.09. 

The  average  of  the  boys  in  the  control  group  was  74.21  and 
for  the  first  group  after  operation  74.06.  "It  is  interesting  to 
note,"  says  the  author,  "that  the  standing  of  slightly  more 
than  half  of  those  operated  on  was  improved,  but  when  com- 
pared with  those  not  operated  on,  no  difference  is  seen." 

In  a  similar  study  of  younger  boys  who  had  undergone  the 
operation  on  entering  college,  and  who  had  since  had  a  year's 
study  (again  a  group  of  45),  the  general  average  was  76.61. 
Compared  to  45  in  the  same  classes  not  operated  on,  who  had 
•an  average  of  74.56,  the  operative  group  is  very  slightly  su- 
perior, 2.05  points. 

Another  study  of  pedagogical  improvement,  and  a  valu- 
able contribution,  is  that  reported  by  A.  H.  McPhail  in  Peda- 
gogical Seminary  for  June,  1920,  entitled  "Adenoids  and 
Tonsils;  a  Study  showing  how  the  Removal  of  Enlarged  or 
Diseased  Tonsils  affects  a  Child's  Work  in  School." 

"The  children  studied  were  pupils  in  the  Adams  and 
Cranch  Schools.  Only  cases  were  considered  where  there  was 
a  record  of  ten  school  months  before  the  date  of  the  operation, 
and  where  there  was  a  record  for  at  least  ten  month  after  the 
operation.    There  were  thirty-one  cases  in  all. 

"School  records  were  looked  up  for  the  ten  school  months 
preceding  operation,  and  for  each  school  month  subsequent — 
up  to  the  date  of  leaving  school,  or  in  the  case  of  children  still 
in  school,  up  to  the  date  of  the  study.  There  were  thus  longer 
school  records  for  some  than  for  others. 

"The  history  of  each  case  was  divided  into  periods  of  ten 
school  months  each.  Eighteen  cases  had  a  record  of  twenty 
months  after  operation  and  eleven  cases  of  thirty  months. 


20  ADENOIDS  AND  DISEASED  TONSILS: 

"Comparing  the  first  period  after  the  operation  with  the 
period  before,  it  is  found  that  only  about  one-third  showed  im- 
provement, and  a  little  over  half  were  doing  poorer  work.  By 
comparing  an  average  of  all  work  done  subsequent  to  the  op- 
eration with  what  was  done  before,  it  became  evident  that  im- 
provement in  school  work  is  not  often  observed  until  after  a 
year  from  the  date  of  the  operation," 

In  the  cases  that  had  records  for  twenty  months,  16  show 
that  better  work  was  done  in  the  second  period  after  the  op- 
eration than  in  the  period  before. 

TABLE  A 
Table  showing  where  improvement  begins. 

Per  Cent  of  cases  showing  improvement 


Period  1 

Period  2 

Period 

Based  on  31  cases 

32.2 

Based  on  18  cases 

33.3 

66.6 

Based  on  11  cases 

36.3 

63.5 

100 

Based  on  all  groups 

33.9 

65. 

100 

These  cases  were  compared  with  a  control  group  chosen  at 
random.  They  comprised  a  total  of  100  children  who  had 
records  for  four  consecutive  school  years. 


TABLE  B 

Table  showing  how  time  of  improvement  of  "operated  cases"  compares 
with  improvement  among  children  at  random. 

Period  1  Period  2  Period  3 

A— Per  cent  of  31  cases  32.2 

(operated  upon) 
Per  cent  of  100  children  42. 

at  random 
B— Per  cent  of  18  children— 20     33.3  66.6 

months  (operated  upon) 
Per  cent  of  100  children  at       42,  41. 

random 
C— Per  cent  of  11  cases  for  30     36.3  63,5  100 

months  (operated  upon) 
Per  cent  of  100  children  at        42.  41.  41 

random 

" Immediately  after  operation,  there  seems  to 

be  a  dropping  off  in  the  quality  of  school  work  done,"  but 
thereafter  a  marked  improvement  while  the  random  group 
shows  a  comparatively  static  percentage  of  improvement 
from  year  to  year.    The  conclusion  of  the  author  is : 


THEIR  EFFECT  UPON  GENERAL  INTELLIGENCE  21 

"Here  seems  good  reason  to  believe  that  the  removal  of 
diseased  tonsils  and  adenoids  is  a  factor  in  beneficially  influ- 
encing the  mental  life  of  the  school  child.  Not  only  is  the 
health  impaired  by  failure  to  remove  these  diseased  parts  but 
the  mental  life  and  activity  of  the  child  as  well." 

It  is  conceivable  that  pedagogical  retardation  might  exist 
without  any  defect  of  intelligence.  The  physical  effects  of 
adenoids  and  tonsils  might  produce  a  tendency  to  fatigue,  an 
emotional  instability  and  consequent  lack  in  attention,  which 
would  seriously  influence  the  quality  of  school  work,  even 
though  the  child  were  of  normal  or  superior  intelligence.  The 
relation  of  physical  defects  to  intelligence  has  been  investigat- 
ed experimentally  by  a  method  which  will  be  employed  to  some 
extent  in  the  present  investigation.  In  the  two  studies  to 
which  I  refer  psychological  tests,  rather  than  school  standings 
were  used  as  a  basis  for  judging  the  intelligence.  In  each  the 
effects  of  treatment  were  measured,  and  in  one,  a  control 
group  makes  possible  a  more  accurate  interpretation  of  re- 
sults. 

The  first  of  these  investigations  is  described  by  Wallin.* 
It  was  "an  attempt  to  determine  by  controlled,  objective,  men- 
tal measures  the  influence  of  hygiene  and  operative  dental 
treatment  upon  the  intellectual  efficiency  and  working  capac- 
ity of  a  squad  of  twenty-seven  public  school  children  in  Mari- 
on School,  Cleveland,  Ohio  (ten  boys  and  seventeen  girls), 
all  of  whom  were  handicapped  to  a  considerable  degree  with 
diseased  dentures  or  gums,  and  an  insanitary  oral  cavity." 
The  experiment  extended  over  one  year,  from  May,  1910,  to 
May,  1911.  The  treatment  included  corrective  work  upon 
the  teeth  and  mouth,  and  also  instruction  in  oral  hygiene,  and 
follow-up  work  by  an  employed  nurse.  Five  series  of  psycholog- 
ical tests  were  given  at  stated  intervals  during  the  course  of 
the  experiment.  They  included  tests  of  immediate  recall, 
spontaneous  and  controlled  association  (opposites),  adding, 
and  attention-perception  (cancellation).  There  were  six  sets 
of  each  test,  numbered  from  one  to  six,  of  equal  difficulty,  and 
given  under  uniform  conditions.  Tests  1  and  2  were  given 
before  the  treatment  began,  and  the  average  was  taken  as  the 
"initial  efficiency."  The  last  four,  or  the  last  two,  were  aver- 
aged to  represent  the  pupils'  "terminal  efficiency." 


*Wallin:  "Mental  Health  of  the  School  Child."  1914. 


22  ADENOIDS  AND  DISEASED  TONSILS: 

The  results  show  the  following  influence  of  dental  treat- 
ment upon  the  working  efficiency  of  the  pupils. 

1.  The  indices  of  improvement  are  about  the  same  for  boys 
and  girls. 

2.  Improvement  was  about  the  same  for  older  and  younger 
pupils. 

3.  There  were  great  individual  differences  in  initial  pro- 
ficiency and  in  improvement. 

4.  Improvement  in  one  test  does  not  presuppose  improve- 
ment in  another. 

5.  There  is  a  decided  gain  in  every  test,  "and  not  only  are 
the  gains  decidedly  more  frequent  than  the  losses  but  the  larg- 
est gains  are  invariably  emphatically  larger  than  the  largest 
losses." 

6.  The  average  gains  in  the  tests  were: 
Memory,  19  per  cent  with  8  losses  and  19  gains. 
Spontaneous  association,  42  per  cent  with  2  losses  and 

25  gains, 

Addition,  35  per  cent  with  1  loss  and  26  gains. 
Controlled  association,  29  per  cent  with  0  losses. 
Perception-attention,  69  per  cent  with  0  losses. 
Average  gain  for  all  tests,  57  per  cent. 

Unfortunately,  Wallin  was  unable  to  form  a  control 
group,  so  that  it  is  impossible  to  estimate  accurately  how  much 
of  this  gain  is  due  to  the  treatment  of  the  defect,  and  how 
much  to  other  causes,  such  as  growth,  etc.  "But,"  the  writer 
adds,  "if  we  concede  that  one-half  of  the  gain — and  that  is,  I 
believe,  a  sufficiently  liberal  concession — is  due  to  a  number  of 
extrinsic  factors,  such  as  familiarity,  practice  and  increased 
maturity,  the  gain  solely  attributable  to  the  heightened  men- 
tation resulting  from  the  physical  improvement  of  the  pupils 
would  still  be  very  considerable.  There  is  corroborative  evi- 
dence to  show  that  there  was  a  general  improvement  in  the 
mental  functioning  of  these  pupils.  This  evidence  is  supplied 
by  the  examination  of  the  pedagogical  record  of  scholarship, 
attendance  and  deportment.  Most  of  the  members  of  this 
experiment  squad  were  laggards,  and  repeaters,  pedagogically 
retarded  in  their  school  work  from  one  to  four  years,  but 
during  the  experiment  year  only  one  pupil  failed  of  promotion. 


THEIR  EFFECT  UPON  GENERAL  INTELLIGENCE  23 

while  six  did  thirty-eight  weeks  of  work  in  twenty-four  weeks, 
and  one  boy  finished  two  years  of  work  within  the  experiment- 
al year." 

The  second  investigation  was  equally  careful  in  its  method. 
It  was  pursued  by  the  Rockefeller  Foundation,  under  the  di- 
rection of  E.  K.  Strong,  with  the  purpose  of  examining  the 
"Effects  of  Hookworm  Disease  on  the  Mental  and  Physical  De- 
velopment of  Children." 

The  children  were  divided  into  five  groups  and  tested  at 
intervals  of  three  and  one-half  months.  The  tests  used  were 
opposites,  calculation,  logical  memory,  memory  span,  hand- 
writing, formboard,  and  Binet-Simon.  After  the  first  test- 
series  was  given,  the  five  groups  were  divided  into  sub-groups 
on  the  basis  of  this  initial  performance,  so  that  the  improve- 
ment was  compared  only  for  those  sub-groups  in  which  this 
was  equal. 

The  improvement  of  Group  A — uninfected  children — 
proved  to  be  greatest,  and  was  taken  as  100  per  cent.  On  this 
basis.  Group  B — infected  children  not  treated — showed  the 
least  improvement, — only  34  per  cent.  Group  C — children 
completely  cured  of  infection — improved  60  per  cent.  Group 
D — severely  infected  children,  treated  but  not  completely  cured 
— improved  38  per  cent,  and  Group  Du — an  older  sub-group  of 
D — improved  9  per  cent  as  much  as  the  normal  children,  and 
much  less  than  the  untreated  younger  children.  Dr.  Strong 
reaches  the  following  conclusion : 

"The  figures  show,  then,  that  hookworm  disease  unmis- 
takably affects  mental  development.  Treatment  alleviates 
this  condition  to  some  extent  but  it  does  not,  immediately,  at 
least,  permit  the  child  to  gain  as  he  would  if  he  had  not  had 
the  disease.  And  the  figures  apparently  further  show  that 
prolonged  infection  may  produce  prolonged  effects  upon  men- 
tality,— effects  from  which  the  individual  may  never  recover." 


CHAPTER  11. 

METHOD  AND  PROCEDURE 

The  following  investigation  was  carried  on  during  the  year 
and  a  half  from  October,  1919,  to  April,  1921.  The  subjects 
were  pupils  at  Public  School  64,  Manhattan,  or  patients  at  the 
Manhattan  Eye,  Ear  and  Throat  Hospital.  All  were  boys, 
between  the  ages  of  six  and  fourteen  years.  The  testing  in  the 
study  of  improvement  was  done  by  the  investigator,  assisted 
by  three  other  examiners,  all  competent  and  experienced  in 
the  technique  of  giving  psychological  tests. 

A  Statistical  Study 

In  addition  to  the  more  lengthy  experiment,  a  statistical 
study  was  made,  comparing  the  intelligence  levels  of  two 
groups  of  children,  the  one  selected  for  the  presence  of  tonsils, 
the  other  for  freedom  from  them.  These  two  groups  were  ob- 
tained from  a  large  group  of  530  children  whose  I.  Q.'s  were 
gained  from  the  records  of  Public  School  64,  where,  so  far  as 
possible,  all  children  are  tested  upon  entering  school.  We  had, 
therefore,  a  group  unselected  for  intelligence  level. 

All  the  children  for  whom  we  had  I.  Q.'s  were 
examined  by  the  school  nurse  or  physician.  On  the  basis  of 
this  examination  the  two  groups  were  selected.  The  tonsil 
group  consisted  of  those  cases  which  in  the  opinion  of  the 
nurse  or  doctor,  were  pronounced  enough  to  deserve  treat- 
ment. The  normal  group  was  composed  of  those  who  were  not 
defective,  or  in  whom  the  defect  was  so  slight  as  not  to  demand 
treatment.  The  two  groups  were  arranged  each  in  a  surface 
of  distribution  according  to  the  I.  Q.'s  of  the  members.  The 
results  of  the  distribution  appear  in  Table  I,  and  in  Figs.  I. 
and  II. 

A  Study  of  Improvement  After  Treatment 
The  method  employed  here  is  based  on  the  hypothesis  that 
if  a  physical  defect  is  the  cause  of  retardation  in  mental  or 
physical  development,  removal  of  the  cause  will  tend  to  lessen 

24 


THEIR  EFFECT  UPON  GENERAL  INTELLIGENCE  25 

"the  retardation.  In  other  words,  if  a  child's  working  efficien- 
cy is  lowered  by  the  effects  of  adenoids  and  bad  tonsils,  their 
removal  should,  unless  such  lowering  be  permanent,  be  fol- 
lowed after  a  reasonable  time  by  an  improvement.  But  im- 
provement in  efficiency,  following  the  removal  of  adenoids  and 
tonsils  proves  nothing  unless  we  shall  compare  it  with  the 
change  in  efficiency  of  a  control  group,  whose  members  have 
not  been  operated  on,  and  who  thus  still  suffer  from  the  effects 
•of  the  growths. 

Selection  of  Cases 

The  selection  of  the  children  for  the  experiment  was  effect- 
ed in  the  following  manner.  The  teachers  at  Public  School  64 
wre  asked  to  report  any  cases  which  had  come  to  their  notice, 
as  being  seriously  afflicted  with  adenoids  and  diseased  tonsils. 
In  this  way  a  fairly  large  group  was  obtained.  The  parents 
of  the  children  were  visited  with  the  purpose  of  obtaining  per- 
mission for  examination  and  operation  at  the  Post  Graduate 
Hospital.  It  was  fairly  easy  to  obtain  permission  to  have  the 
children  examined.  They  were  taken  in  groups  of  four  or  five 
to  the  clinic,  the  experimenter  attending  in  person  every  ex- 
amination in  order  to  learn  from  the  doctors  the  degree  of  the 
defect.  As  a  result  of  this  method,  we  discarded  all  those 
cases  where  there  was  any  doubt  as  to  the  serious  nature  of 
the  defect. 

F'rom  the  large  group  examined,  we  were  finally  successful 
in  securing  operative  treatment  for  10  children.  Discarding 
the  cases  where  defect  was  slight,  there  remained  a  number  of 
children  who,  for  one  reason  or  another,  did  not  undergo  op- 
eration. In  some  instances  the  parents  refused  their  permis- 
sion, in  some  they  failed  to  keep  appointments,  in  one  or  two 
there  was  sickness  in  the  family,  and  in  a  number  the  hos- 
pital was  overcrowded  and  could  not  receive  the  children. 
All  members  of  this  group  were  examined, — to  the  number  of 
fifty-six,  and  from  them  the  control  group  was  finally  selected. 

Since  we  were  unable  to  secure  a  large  test  group  from 
Public  School  64,  the  experiment  was  continued  at  the  Man- 
hattan Eye,  Ear  and  Throat  Hospital  where  opportunity  was 
given  for  testing  the  children  after  they  had  been  admitted 
for  operation.  In  order  to  be  sure  that  in  each  case  the  defect 
was  sufficiently  pronounced  to  render  decisive  the  results  of 
the  experiment,  each  child's  card  was  examined.    Only  those 


26  ADENOIDS  AND  DISEASED  TONSILS: 

children  were  included  who  were  undergoing  operation  for' 
both  adenoids  and  tonsils. 

It  may  be  here  remarked  that  mental  tests  were  given  to 
these  children  on  the  morning  of  operation,  and  in  some  cases 
only  a  short  time  before  it.  The  possibility  suggests  itself, 
therefore,  that  the  results  of  the  tests  may  have  been  influ- 
enced by  excitement  or  fright  on  the  part  of  the  patients.  Ac- 
tually, however,  this  did  not  seem  to  be  the  case.  The  children 
were  perfectly  cheerful  and  showed  no  signs  of  nervousness. 
The  tests  were  given  in  a  waiting  room  with  the  door  closed 
so  that  any  disturbing  sights  and  sounds  were  eliminated.  The 
possible  lowering  of  the  performance  by  the  causes  mentioned 
would  tend  to  exaggerate  the  improvement  shown  by  the  re- 
tests,  so  that  in  the  light  of  the  results,  it  will  be  seen  that 
they  could  have  had  little  effect. 

The  test  group,  then,  was  composed  of  forty  members; 
ten  from  Public  school  64,  who  received  operation  at  the  Post 
Graduate  Hospital,  and  the  remaining  thirty  from  various 
schools  throughout  the  city,  patients  at  the  Manhattan  Eye, 
Ear  and  Throat  Hospital.  The  control  group  of  forty  was  se- 
lected as  previously  described,  and  the  pairs  were  arranged  so 
as  to  have  the  ages  of  the  members  of  one  pair  as  nearly  as 
possible  the  same. 

The  Tests 

Since  the  main  interest  of  this  investigation  lies  with 
intellectual  development,  two  tests  of  intelligence  were  given : 
namely,  Terman's  revision  of  the  Binet  test,  and  Healy's  Pic- 
ture Completion  Test,  number  II.  The  starred  Terman  was 
always  used,  since  it  was  necessary  to  economize  time. 

It  was  expected  that  improvement  in  general  health 
would  probably  follow  the  removal  of  the  defects.  This  physi- 
cal gain  should  come  to  light  in  increased  height  and  weight. 
In  every  case,  therefore,  height  and  weight  were  measured. 

It  is  conceivable  that  adenoids  and  tonsils  might  have  no 
effect  upon  general  intelligence,  and  yet  might  cause  a  notice- 
able pedagogical  retardation,  simply  as  a  result  of  the  child's 
physical  handicap,  tendency  to  fatigue  and  consequent  defect 
in  attention  or  sustained  effort.  In  order  to  gain  some  meas- 
ure of  this  physical  factor,  strength  of  grip  and  speed  in  tap- 
ping were  found.    An  effort  was  made,  also,  to  obtain  teach- 


THEIR  EFFECT  UPON  GENERAL  INTELLIGENCE  27 

ers*  estimates  of  the  pedagogical  rankings,  but  this  was  for 
the  most  part  unsuccessful,  since  in  many  cases  teachers  mis- 
understood directions,  and  in  others  the  tests  were  made  too 
soon  after  the  opening  of  school  for  any  such  estimates  to  be 
possible. 

The  tests  described  above  were  given  before  the  operation 
to  each  child  in  the  test  group,  allowing  as  short  an  interval 
as  possible  between  test  and  operation.  In  the  case  of  the 
Manhattan  Hospital  children,  test  and  operation  fell  on  the 
same  day.  In  no  case  did  the  interval  exceed  ten  days.  The 
members  of  the  control  group  were  tested,  each  one  within  a 
week  of  his  partner.* 

Six  months  after  his  first  test,  each  child  was  re-tested, 
whenever  possible.  Since  some  children  had  dropped  out  of 
the  groups  for  one  reason  or  another,  the  final  number  in 
each  group  was  twenty-eight.  It  was  necessary  to  rearrange 
the  control  cases  somewhat  in  order  to  fill  in  spaces  left  va- 
cant by  those  who  were  lost.  In  this  rearrangement,  the  effort 
was  made,  1.  to  pair  cases  whose  ages  were  approximately 
the  same;  2.  to  pair  cases  whose  first  tests  were  dated  fairly 
close  together.  Since  all  the  children  were  tested  and  re-tested 
under  approximately  the  same  conditions,  this  rearrangement 
will  probably  not  greatly  influence  the  results.  The  tests  were 
always  given  in  the  same  order. 

The  following  table  shows  a  list  of  the  two  groups,  as 
originally  paired,  and  as  finally  rearranged,  with  dates  of 
tests  and  retests.  Dates  of  operation  are  given  for  the  first 
group. 


*In  a  few  cases  where  the  operation  was  postponed  after  the  test 
had  been  given,  the  child  and  his  control  were  retested  just  previous  to 
the  operation.  Since  both  cases  were  retested,  practice  effect  is  of  no 
great  importance. 


28  ADENOIDS  AND  DISEASED  TONSILS: 


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CHAPTER  III. 
DISCUSSION  OF  THE  RESULTS 

Statistical  Study 

The  statistical  study  compared  two  groups  of  cases  in  re- 
spect to  I.  Q.  These  groups  were  selected  from  one  large 
group,  on  the  basis  of  presence  or  absence  of  tonsillar  defect. 
The  tonsil  group  was  composed  of  236  cases,  and  the  normal 
group,  of  294.  The  distribution  of  the  two  groups  according 
to  intelligence  is  set  forth  in  Table  I,  and  in  Figs.  I  and  II. 

TABLE  I 


LQ. 

40-  50 

50-  60 

60-  70 

70-  80 

80-  90 

90-100 

100-110 

110-120 

120-130 

130-140 

140-150 

Average 
Median 

Q 


From  these  it  is  evident  that  the  two  groups  are  practically 
equal  in  intelligence.  The  average  I.  Q.  for  the  normal  group 
is  95.4,  as  compared  with  94.9  for  the  tonsil  group.  The  me- 
dians are  equally  close, — 95.6  in  the  normal  group  and  95.3 
with  the  tonsil  cases.  The  difference  in  variability  is  negli- 
gible, Q  being  8.705  and  o- 14.4  in  the  tonsil  group,  while  in  the 
normal  Q  is  8.27  and  o-  12.2.  The  two  cases  with  the  lowest 
I.  Q.'s  were  tonsil  cases,  but  the  three  highest  I.  Q.'s  also  be- 
long in  this  group. 

29 


Tonsil 

Group 

Normal 

Group 

No.  of 

Per  cent  of 

No.  of 

Per  cent  of 

Cases 

Cases 

Cases 

Cases 

2 

.8 

0 

0 

1 

.4 

2 

.7 

7 

2.9 

4 

1.4 

21 

8.9 

29 

9.8 

45 

19.0 

52 

17.7 

80 

33.9 

107 

36.4 

55 

23.3 

67 

22.8 

17 

7.2 

24 

8.1 

6 

2.5 

9 

3.0 

2 

.8 

0 

0 

1 

.4 

0 

0 

94.9 

95.4 

95.3 

95.6 

8.705 

8.27 

14.4 

12.2 

30 


ADENOIDS  AND  DISEASED  TONSILS: 


I.a    fO 


t  b 


■P 


60 


Tbnsi  I  §roup  ,««_ 
czz3«3Cdse$ 


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ro  too 

Fig,  1.    Distribution  of  I.  Q.'s.    Number  of  cases. 


1^0 


-fO 


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J^^^"^ 


Tonsil  ^roup  .^ 

Norm&l  6roup 

■sx%  of  cases 


60 


TO 


/oo 


ao 


»fO 


Fig.  2.     Distribution  of  I.  Q.'s  by  percentage  of  total  number 
of  cases  in  the  group. 


THEIR  EFFECT  UPON  GENERAL  INTELLIGENCE  31 

If  the  frequencies  are  expressed  in  terms  of  per  cent  of 
the  total  number  of  cases  in  the  group,  the  two  may  be  com- 
pared further.    The  following  details  are  noticeable. 


I.Q. 

Per  cent  of  Tonsil  Group 

Per  Cent  of  Normal  Group 

Below  70 

4.1 

2.1 

Below  90 

32.0 

29.6 

Above  110 

10.9 

11.1 

Above  120 

3.7 

3.0 

Above  130 

1.2 

0 

In  other  words,  in  the  percentage  of  cases  below  normal 
intelligence,  the  tonsil  group  exceeds  by  2.4  per  cent.  The  per- 
centage of  defective  cases  is  also  slightly  greater  in  the  tonsil 
group — ^the  difference  here  being  2  per  cent.  The  normal 
group  has  a  negligible  predominance  of  bright  cases, — only 
two-tenths  of  one  per  cent  difference,  while  with  the  very 
superior  cases,  the  tonsil  group  again  exceeds, — by  1.2  per 
cent.  The  per  cent  of  the  tonsil  group  which  reaches  or  ex- 
ceeds the  median  of  the  normal  is  49  per  cent. 

These  figures  seem  to  indicate  remarkable  similarity  be- 
tween the  two  groups  considered.  The  two  distributions  are 
almost  identical.  While  the  slight  predominance  of  cases  be- 
low normal  mentality  in  the  tonsil  group  may  indicate  a  very 
feeble  tendency  toward  coincidence  of  tonsillar  defect  and 
mental  dullness,  it  does  not  seem  large  enough  to  be  at  all 
significant.  This  is  especially  true  when  we  consider  that  the 
tonsil  group  exceeds  in  superior  children.  If  we  allow  the 
preceding  contention  of  coincidence  between  dullness  and 
tonsils,  must  we  not  argue  here  in  the  same  manner  for  a  ten- 
dency toward  coincidence  of  superiority  and  tonsils? 

The  chief  source  of  error  in  this  part  of  the  study  is  the 
fact  that  the  throat  examinations  were  not  conducted  by  the 
same  person  throughout  the  investigation.  For  his  reason 
there  must  have  been  some  slight  disagreement  as  to  what 
should  constitute  a  reportable  case.  In  the  event,  then,  of  a 
positive  relationship  between  tonsil  defect  and  lowering  of  the 
intelligence  quotient,  placement  of  normal  tonsils  in  the  "ton- 
sil" group,  and  of  diseased  tonsils  in  the  "normal"  group 
would  raise  the  first,  and  lower  the  second,  thus  tending  to 
conceal  the  difference  between  the  two.  On  the  other  hand, 
the  cases  where  disagreement  would  occur  would  naturally 
be  those  of  slighter  defect,  in  which  the  intellectual  retarda- 
tion would  be  less  likely  to  occur,  so  that  the  result  would 


32  ADENOIDS  AND  DISEASED  TONSILS: 

probably  be  merely  an  increased  height  at  the  overlapping- 
portion  of  the  curves,  with  no  change  at  the  ends. 

In  any  case,  the  two  examiners  had  worked  together  pre- 
viously, so  that  each  must  have  been  somewhat  familiar  with 
the  opinions  of  the  other.  They  were  aware,  also,  that  pro- 
nounced tonsillar  defect  was  what  we  were  attempting  to  de- 
tect. However  this  may  be,  there  must  always  be  some  dis- 
agreement in  diagnosis.  When  this  is  allowed  for,  the  results, 
of  the  investigation  may  be  taken  for  what  they  are  worth. 
Contrary  to  expectation,  there  seems  to  be  very  little  differ- 
ence in  intelligence  between  a  group  of  children  whose  throats 
are  normal,  and  one  in  whom  the  tonsils  are  diseased  or  badly 
enlarged. 

STUDY  OF  IMPROVEMENT  AFTER  OPERATION 

The  complete  results  of  the  tests  and  retests  are  collected 
in  Table  II,  where  each  control  case  is  listed  immediately  be- 
low its  respective  test  case,  and  where  age,  height,  weight, 
grip,  tapping  rate,  I.  Q.,  and  score  in  Healy  Picture  Comple- 
tion are  shown.  From  these  data  the  more  detailed  observa- 
tions have  been  made.  The  improvement  of  each  child  in  the 
various  tests  has  been  computed,  and  a  comparison  drawn 
between  the  two  groups.  As  we  have  previously  stated,  any 
improvement  shown  by  the  test  group  in  excess  of  that  of  the 
control  group,  may  be  looked  upon  as  significant. 

Let  us  consider  first  the  improvement  of  the  children  in 
general  health,  as  shown  by  height  and  weight.  In  Tables  III 
and  IV  we  have  tabulated  the  results,  in  such  shape  as  to  per- 
mit of  comparison.  An  inspection  of  these  tables  will  estab- 
lish the  fact  that  after  a  six  months'  interval,  the  test  group 
shows,  in  respect  to  height  and  weight,  a  very  slight  gain  over 
the  control  group.  In  weight,  the  average  of  the  amounts 
by  which  the  test  group  gains  exceed  the  control  group  gains 
is  1.37  lbs.,  and  in  height,  only  .16  inches.  The  medians  of 
these  amounts  are  1.2  lbs.  and  .2  inches  respectively.  Compar- 
ing the  improvements  for  the  two  groups,  we  find  that  in  the 
case  of  the  weights,  the  smallest  gain  (a  loss  of  1.2  lbs.)  occurs 
in  the  control  group,  while  the  largest  gain  (10.7  lbs.)  is  in  the 
test  group. 


THEIR  EFFECT  UPON  GENERAL  INTELLIGENCE  33 

TABLE  II.  RESULTS  OF  TESTS 
Blank  spaces  indicate  where  tests  were  omitted  for  one  reason  or  another 
N  -Age  Weight  Height  Grip,  Kg. 

lbs.  in.  best  hand 

1  2  121212 

1  7-7  8-1         50.4         54.2         46  47.6         13  12 
IC              8-1           8-7         53.5         57.2         46.4         47.8         11  13 

2  6-9  7-3         40.9         42.9         42.6         41.1  9  9 
2C             7-1           7-7         52.3         57.4         45.2         47            10            12 

3  8-  8-6         55  59.5         47  48.4         12.8         14.5 
3C             9-  9         10-  3         61.5         62.9         51.7         52.9         14  15 

4  8-10  9-  4         51.1         54.2         47.5         49.2  9  

4C  9-10         10-  4         49.4         51  48.9         52  9.5        


5  6-1  6-  7  45  47  44.9  45.2  11           

5C  8-2  8-8  56.2  57  46.6  48.1  12           

6  5-2  5-8  43.8  44.5  43.1  43.9           8           

6C  7-1  7-7  50.6  52.5  45.4  47.3  10.5        

7  6-7  7-1  39.9  41  42.9  44.8           7  6.5 
7C  6-7  7-1  38.4  38.7  41.9  43.2           9  10 

8  8-6  9-  60.8  63.3  50.8  51.8  10           


8C  8-  5  8-11  45.4  52.1  46.8         47.6  15  16 

9  9-4  9-10  50.6  53.2  48.1         49.4  10.5  13 
9C  9-  6  10-  59.8  61.4  51.9         55.2  16.5  21 

10  6-7  7-1  48.9  51.4  46.1         47.7  12.5  11 
IOC  7-  7-  6  47.1  47.5  45.6         47.2  10  15 

11  6-  7  7-  47.8  47.5  45.8         47.7  11  15 
lie  6-8  7-1  41.6  42.5  43.6         44.9  11.5  11.5 

12  7-8  8-2  48  52.5  44.8  14  

12C  7-1  7-8  41  44.5  41.5  43.3           6              4.5 

13  13-  3  13-10  90  98  61.5         65  26.5  28.5 
13C  14-  6  15-  74.7  76.8  56.8  57.8  22  23 

14  11-  9  12-  4  56  62  51  51.6  16  15 
14C  11-10  12-  4  81.9  86  57.9  58.3  22  24 

15  10-  3  10-10  57.5  51.1  15.5  

15C  10-  1  10-  7  67.2  70.3  50.1  51  15  15.5 

16  10-  9  11-  3  56  57  51.6  52.3  19  17.5 
16C  10-  9  11-  3  51.2  50  48.7  49.5  10  10 

17  8-1  8-7  57  48.7  14  


17C     7-10     8-  4    45.3   44.8   10      8.5 

18      7-2     7-8    58.2   47.3   11     


18C     6-11     7-  5    45.3    47     46.7    47.1     8      6.5 

19     11-  4    11-10    90     96.3    57.7    59     22     21 
19C     7-11     8-  5    52.4    54.4    46.7    47.2    15     12 


34  ADENOIDS  AND  DISEASED  TONSILS: 

TABLE  II.     RESULTS  OF  TESTS   (Continued) 
Blank  spaces  indicate  where  tests  were  omitted  for  one  reason  or  another 


N 

Age 

Weight 
lbs. 

Height 
in. 

Grip,  Kg. 
best  hand 

20 
20C 

7-  1 
7-  3 

7-  7 
7-10 

44.2 
61.3 

66 

47.2 
49.6 

55 

11. 

15 

12.5 

21 
21C 

11- 
10-  1 

11- 
10- 

6 

7 

70.7 
62.4 

76.5 
67 

54.1 
49.6 

50.4 

16.5 
19 

16.5 
15 

22 
22C 

10-  9 

11-  7 

11- 
12- 

3 
1 

73.3 

70.7 

80.5 

53 

56.8 

56.4 
58.1 

18 
19.5 

22.5 
21.5 

23 
23C 

8-  7 
8-11 

9- 
9- 

1 
4 

51.7 
64.1 

66.5 

47.8 
51.4 

53.1 

11.5 
14.5 

15.5 

14 

24 
24C 

9-  8 
10-  2 

10- 
10- 

2 

8 

58.5 
60 

62.5 
61 

51 
50.1 

51.5 

19 
15 

20 
15 

25 
25C 

10-  1 
10-10 

10- 
11- 

7 
4 

55.5 
63.3 

59.5 
63.8 

50 
50.2 

50.8 
50.9 

14 
12.5 

21.5 

26 
26C 

9-  8 
10-  4 

10- 
10- 

2 
9 

63.8 
64.2 

74.5 
67 

51.6 
51.4 

54.3 
52.3 

14 
20 

16.5 

27 
27C 

6-  7 
6-  3 

7- 
6- 

1 
9 

43.7 
41 

44 

45.4 
44.6 

45.4 

9 

8 

6 
9 

28 
28C 

12-11 
13-  8 

13- 
14- 

5 
2 

71.3 

74.2 

75.5 
79.8 

54.9 
53.4 

55.8 
54.5 

23.5 
21 

21 

TABLE  II.    RESULTS   (Continued) 
Blank  spaces  indicate  where  tests  were  omitted  for  one  reason  or  another 


N 

Tapping,  %  min. 
best  hand 

1 

IC 

1 
135 
106 

2 

120 
115 

2 
2G 

105 
152 

112 
114 

3 
:3C 

136 
135 

139 
129 

4 
4C 

103 
109 

5 
5C 

110 
156 

6 
6C 

110 
126 

7 
7C 

125 
105 

113 

8 
8C 

113 
131 

110 
101 

I. 

Q. 

Healy,  1 

Score 

1 

82 
80 

2 

83 
76 

1 
—25 
—50 

2 
—  2 

—16 

107 
91 

114 
96 

28.5 
3 

30 
—11 

94 
82 

91 
85 

21.5 
17 

22.5 
19 

96 
83 

96 
85 

8.5 
33 

95 
114 

99 
117 

—25 
40.5 

95 
88 

91 
95 

101 
89 

99 
99 

—33 
—32 

6 
4.5 

—28 
27.5 

91 

98 

86 
104 

32.5 

4 

23 

THEIR  EFFECT  UPON  GENERAL  INTELLIGENCE 


35 


TABLE  II.    RESULTS  (Continued) 
Blank  spaces  indicate  where  tests  were  omitted  for  one  reason  or  another 
N  Tapping,  J^  min.  I.  Q.  Healy,  Score 


best  hand 

9  149  135  83  93 

9C  144  150  87  90 


10 
IOC 

11 

lie 

12 
12C 

13 
13C 

14 
14C 

15 
15C 

16 
16C 

17 

17C 

18 
18C 

19 

19C 

20 
20C 

21 
21C 

22 
22C 

23 
23C 

24 
24C 

25 

25C 

26 
26C 

27 
27C 

28 
28C 


68+  74 
70+  54 

125+  90 
155+125 

98+  69 
102 

160+165 
150+109 

190+172 
175+152 

172+167 
140+115 

145+131 

145+  99 

90+  89 
125+116 

133+115 
100+  99 

168+136 
100+115 

105+115 
150+120 

152+111 
140+136 

164+148 
120+116 

150+119 
122+115 

157+136 
155+135 

140+127 
148+134 

137+113 
125+105 

108+  92 
115+105 

150+148 

178+148 


88+  82 
135+109 

98+  87 
101+107 


84 


142+134 

122+  94 

138+130 
175+164 

170+156 
137+115 


135+135 

150+100 
121+  97 

135+111 

84+  74 


118+  92 

110+  93 
155+149 

132+125 
138+110 

183+141 

157+127 

141+136 
140+110 

142+126 
155+100 

150+119 
151+135 

138+117 
125+  79 

97+  92 
112+109 

162+143 
170+163 


110 
104 

103 
101 

98 
98 

70 
66 

96 
140 

97 

78 

65 
74 

71 
96 

98 
90 

96 
98 

106 
118 

64 
86 

91 
63 

85 
81 

131 
89 

77 
145 

80 
90 

110 

72 

81 
95 


109 
100 

100 
102 

95 

101 

78 
64 

107 
137 

94 
79 

73 

82 

77 
99 

98 
94 

101 
98 

102 
131 

67 
97 

100 
62 

94 
96 

124 
92 

76 
137 

76 

88 

109 
96 

84 
98 


3.5 
34 

—12 
27 

—  8 
—29 

20 

—10 

43 

—  1.5 

12.5 

—  5 

7 
1 

49 
30 

29.5 
1.5 

—13.5 
—32 

57.5 
—22 

0 
30 

20 
70.5 

48.5 
34.5 

49.5 

4 

54.5 
31.5 

8 
29.5 

22.5 
56 

—25 
2 

29.5 
64.5 


10.5 
55 

6.5 
65 

6 
—  3.5 

21 

—12 

42 
30.5 

48.5 
25.5 

25 
42.5 

47.5 
37 

12 
15 

—12 

—28 

49 
—11 

—11 
35 

32 
58.5 

43.5 
33.5 

68 
25 

63 
59.5 

25 
29 

7 
61.5 

15 
27.5 

73.5 
51.5 


36  ADENOIDS  AND  DISEASED  TONSILS: 

We  have  therefore: 

28  pairs  of  I.  Q's  to  be  compared 
21  pairs  of  weights 

19  pairs  of  heights 

16  pairs  of  grip  measurements 

20  pairs  of  tapping  speeds 

24  pairs  of  Healy  Completion  scores. 

Again,  in  only  five  pairs  does  the  gain  of  the  control 
exceed  that  of  the  test  case,  while  in  the  remaining  sixteen 
pairs  the  gains  of  the  test  cases  are  greater  than  those  of 
their  respective  controls.  The  greatest  loss  of  test  as  com- 
pared to  control  is  4.2  lbs.,  while  the  largest  gain  is  7.9.  It 
would  seem  then,  that  after  a  six  months'  interval  a  child  who 
has  been  operated  on  for  adenoids  and  tonsils  will  tend  to  show 
a  slightly  greater  increase  in  weight  than  a  child  who  contin- 
ues to  suffer  from  the  defects.  The  very  small  group  renders 
this  conclusion  far  from  assured.  Since  it  doubtless  takes 
some  little  time  to  recover  from  the  effects  of  the  operation, 
and  since  there  is  comparatively  little  gain  in  weight  in  a 
six  months'  interval,  it  would  be  well  to  extend  the  experiment 
over  another  year.  For  the  greater  reliability  of  results,  some 
degree  of  after-care  should  be  given  the  operative  cases,  the 
control  cases  of  course  receiving  the  same  treatment.  While 
this  was  impracticable  in  the  present  study,  it  happened  that 
three  pairs  of  cases  were  members  of  a  nutrition  class,  and 
therefore  underwent  some  hygienic  treatment.  In  one  pair, 
(no.  11)  the  test  case  lost  .3  of  a  pound,  while  the  control 
gained  .9.  The  test  cases  of  pairs  7  and  10  gained  .8  lb.  and 
2.1  lbs.  respectively,  over  and  above  their  controls.  However, 
these  three  cases  alone  are  of  little  significance. 

A  study  of  increase  in  height  suffers  even  more  than  one 
of  weight  gains  from  the  short  interval  which  elapsed  between 
measurements.  Normally,  there  is  very  little  growth  in  six 
months.  There  are  only  nineteen  pairs  of  cases  in  this  portion 
of  the  study,  a  fact  which  renders  it  of  even  less  value.  How- 
ever, results  are  offered  for  what  they  are  worth.  The  small- 
est increase  in  height  (.3  in.)  is  in  the  test  group,  while  the 
greatest  growth  (3.5  in.)  is  also  in  the  test  group.  There  is, 
however,  a  gain  of  3.3  inches  in  the  control  group  as  well  as 
one  of  only  .4  inches.  There  are  seven  pairs  in  which  the  test 
group  growth  is  less  than  that  of  the  controls,  one  in  which 
the  two  are  equal,  and  in  the  remaining  eleven  the  growth 
of  the  test  cases  exceeds  that  of  the  controls.    The  variability 


THEIR  EFFECT  UPON  GENERAL  INTELLIGENCE 


37 


TABLE  III 
Gain  in  weight,  6  months,  21  pairs 


N* 

Test  Group  (A) 

Control  Group  (B) 

Lbs. 

Test  1      Test  2 

Gain 

Test  1          Test  2 

Gain 

A— B 

8 

60.8         63.3 

2.5 

45.4             52.1 

6.7 

—4.2 

2 

40.9         42.9 

2.0 

52.3             57.4 

5.1 

—3.1 

28 

71.3         75.5 

4.2 

74.2             79.8 

5.6 

—1.4 

6 

43.8         44.5 

.7 

50.6             52.5 

1.9 

—1.2 

11 

47.8         47.5 

—  .3 

41.6             42.5 

.9 

—1.2 

1 

50.4         54.2 

3.8 

53.5             57.2 

3.7 

.1 

7 

39.9         41.0 

1.1 

38.4             38.7 

.3 

.8 

9 

50.6         53.2 

2.6 

59.8             61.4 

1.6 

1.0 

12 

48.0         52.5 

4.5 

41.0             44.5 

3.5 

1.0 

14 

56.0         62.0 

6.0 

81.9             86.0 

4.9 

1.1 

5 

45.0         47.0 

2.0 

56.2             57.0 

.8 

1.2 

21 

70.7         76.5 

5.8 

62.4             67.0 

4.6 

1.2 

4 

51.1         54.2 

3.1 

49.4             51.0 

1.6 

1.5 

10 

48.9         51.4 

2.5 

47.1             47.5 

.4 

2.1 

16 

56.0         57.0 

1.0 

51.2             50.0 

—1.2 

2.2 

24 

58.5         62.5 

4.0 

60.0             61.0 

1.0 

3.0 

3 

55.0         59.5 

4.5 

61.5             62.9 

1.4 

3.1 

25 

55.5         59.5 

4.0 

63.3             63.8 

.5 

3.5 

19 

90.0         96.3 

6.3 

52.4             54.4 

2.0 

4.3 

13 

90.0         98.0 

8.0 

74.7             76.8 

2.1 

5.9 

26 

63.8         74.5 

10.7 

64.2             67.0 

2.8 

7.9 

Av. 

56.86       60.61 

3.76 

56.24           58.60 

2.39 

1.37 

M 

3.8 

1.9 

1.2 

75%ile 

5.8 

4.6 

3.1 

25%ile 

2,0 

.9 

.1 

Q 

1.9 

1.85 

1.5 

P.  E. 

(distribution) 

1.76 

1.39 

1.63 

P.  E. 

(average) 

±.38 

±.30 

±.48 

Av. 

=2.85  P.E. 

M. 

=2.80  P.E. 

of  the  test  group  growth  is  greater  than  that  of  the  control 
group.  The  three  nutrition  pairs  show  the  following  records 
of  growth, — in  number  7,  the  test  case  shows  a  growth  of  .6 
in.  more  than  his  control.  Number  10  is  the  pair  in  which  the 
growth  is  equal.  In  number  11  the  test  case  again  exceeds  in 
growth  by  .6  of  an  inch. 

More  reliable  than  height  and  weight  considered  separate- 
ly, as  an  index  of  physical  welfare,  is  weight  in  relation  to 
height  and  age.  Table  V  shows  the  improvement  in  this  rela- 
tionship for  the  two  groups.  The  numbers  in  columns  1,  2, 
4  and  5  show  the  per  cent  under  or  over  weight  of  the  indi- 
vidual cases,  in  relation  to  their  respective  heights  and  ages. 
The  authority  upon  which  the  figures  are  based,  is  the  table 
published  by  the  American  Child  Health  Association,  giving 
standard  weights  for  height  and  age  in  boys. 


*Numbers  refer  to  cases  as  listed  on  Table  II. 


38 


ADENOIDS  AND  DISEASED  TONSILS: 


There  was  an  average  loss  of  .28  per  cent  in  the  weight- 
height-age  relationship  for  the  test  group,  and  of  2.11  per  cent 
for  the  control  group.  The  average  improvement  of  the  test 
group  in  excess  of  the  control  group  is,  then,  1.83  per  cent. 
The  median  improvement  of  test  group  over  and  above  control 
is  4.00  per  cent.  The  test  group  is  more  variable  than  the 
control  in  improvement.  The  greatest  improvement,  8  per 
cent,  is  found  in  both  groups. 


TABLE  IV 

Gain  in  Height- 

-6  Months, 

19  Pairs 

N* 

Test  Group  (A) 

Control  Group  (B) 

Inches 

Test  1         Test  2        Gain 

Testl 

Test  2      Gain 

A— B 

9 

48.1            49.4            1.3 

51.9 

55.2           3.3 

—2.0 

4 

47.5             49.2             1.7 

48.9 

52.0           3.1 

—1.4 

5 

44.9             45.2               .3 

46.6 

48.1           1.5 

—1.2 

6 

43.1             43.9               .8 

45.4 

47.3           1.9 

—1.1 

2 

42.5             44.1             1.6 

45.2 

47.0           1.8 

—  .2 

28 

54.9             55.8               .9 

53.4 

54.5           1.1 

—  .2 

16 

51.6             52.3               .7 

48.7 

49.5             .8 

—  .1 

10 

46.1             47.7             1.6 

45.6 

47.2           1.6 

0 

25 

50.0             50.8               .8 

50.2 

50.9             .7 

.1 

1 

46.0             47.6             1.6 

46.4 

47.8           1.4 

.2 

3 

47.0             48.4             1.4 

51.7 

52.9           1.2 

.2 

8 

50.8             51.8             1.0 

46.8 

47.6             .8 

.2 

14 

51.0             51.6               .6 

57.9 

58.3             .4 

.2 

7 

42.9             44.8             1.9 

41.9 

43.2           1.3 

.6 

11 

45.8             47.7             1.9 

43.6 

44.9           1.3 

.6 

19 

57.7             59.0             1.3 

46.7 

47.2             .5 

.8 

26 

51.6             54.3             2.7 

51.4 

52.3             .9 

1.8 

22 

53.0             56.4             3.4 

56.8 

58.1           1.3 

2.1 

13 

61.5             65.0             3.5 

56.8 

57.8           1.0 

2.5 

Av. 

49.26           50.79           1.53 

49.20 

50.62         1.36 

.16 

M 

1.4 

1.3 

.2 

75%ile 

1.90 

1.75 

.65 

25%ile 

.78 

.8 

—.43 

Q 

.56 

.48 

.54 

P.  E. 

(distribution)                    .53 

.44 

.44 

P.  E.  ( 

(average)                       ±.12 

±.10 
Av.= 
M   = 

±.16 
:1       p.  E. 
:1.25  p.  E. 

The  greatest  loss,  10  per  cent,  is  in  the  control  group. 
Eight  cases  show  a  loss  in  comparison  to  their  controls,  and 
nine  reveal  a  gain.  On  the  whole,  there  is  some  significance 
in  the  small  net  improvement  manifested  by  the  test  group. 
The  average  is  2.02  P.  E.'s,  and  the  median  4.40  P.  E.'s. 
The  dynamometer  results  show  no  gain  in  strength  of  grip 
six  months  after  operation.    Indeed  the  average  of  the  gains 


♦Numbers  refer  to  cases  as  listed  on  Table  II. 


THEIR  EFFECT  UPON  GENERAL  INTELLIGENCE  39 

of  the  operative  cases  is  slightly  less  than  the  average  gain  of 
the  controls.  Comparing  the  test  group  with  the  control,  we 
find  the  average  of  the  differences  to  be  — .24.  But  the  vari- 
ability is  so  high  (P.  E.  =  +.48)  as  to  render  this  figure  un- 
reliable. The  greatest  loss  in  strength  of  grip  is  found  in  the 
control  group,  but  the  greatest  gain  is  also  in  this  group. 
Seven  cases  in  the  test  group  show  a  loss,  as  compared  with 
only  three  control  cases.  In  eight,  or  one-half  of  the  sixteen 
cases,  the  control  member  of  a  pair  gained  more  than  the  test 
member.  Considering  the  three  pairs  of  nutrition  cases,  we 
find  that  in  pair  number  7  the  test  case  loses  1.5  Kg.  when 
compared  with  the  control;  and  in  pair  number  10,  6.5  Kg., 
while  the  test  case  in  pair  11  gains  4  Kg.  The  conclusion  from 
the  data  would  seem  to  be  that,  within  the  space  of  six  months 
at  any  rate,  operation  for  adenoids  and  tonsils  brings  about 
no  increase  in  strength  of  grip. 

TABLE  V 

Showing  change  in  per  cent  over  or  underweight  for  height  and  age, 

18  pairs 

A  B  A— B 


N* 

1 

2 

3 

4 

5 

6 

7 

8 

.    —  1 

—  1 

0 

—13 

—  5 

-f  8 

—  8 

11 

—  3 

—12 

—9 

—  9 

—11 

—  2 

—  7 

10 

—  1 

—  5 

4 

—  6 

—  8 

—  2 

—  2 

28 

—  7 

—  7 

0 

0 

+  2 

+  2 

—  2 

13 

—13 

—19 

—6 

—11 

—15 

—  4 

—  2 

19 

+  6 

+  8 

+2 

+  1 

+  5 

+  4 

—  2 

6 

+  2 

—  3 

—5 

+  5 

+  1 

—  4 

—  1 

14 

—13 

—  9 

+4 

—  5 

0 

+  5 

—  1 

7 

—  8 

—15 

—7 

—  7 

—14 

—  7 

0 

2 

—  8 

—  6 

+2 

+  9 

+10 

+  1 

+  1 

3 

+  6 

+  8 

+2 

—  5 

—  8 

—  3 

+  5 

16 

—16 

—15 

+1 

—13 

—17 

—  4 

+  5 

25 

—  8 

—  7 

+1 

+  4 

—  1 

—  5 

+  6 

5 

—  4 

—  1 

+3 

+  8 

+  4 

—  4 

+  7 

9 

—  8 

—11 

—3 

—  7 

—17 

—10 

+  7 

26 

—  1 

+  5 

+6 

+  1 

0 

—  1 

+  7 

4 

—  7 

—  7 

0 

—15 

—23 

—  8 

+  8 

1 

0 

+  8 

+8 

+  8 

+  4 

—  4 

+12 

Av. 

—  4.67 

—  4.94 

—  .28 

—  3.06 

—  5.17 

—  2.11 

+  1.83 

M 

+  .5 

—  3.5 

-f  4.00 

75%ile 

+2 

0 

6.5 

257oile 

—2 

—  4.5 

—  2 

Q 

2 

2.25 

4.25 

P.  E. 

(distribution) 

3 

2.39 

1.33 

P.  E. 

(average) 

±.71 

±57         ±91 
Av.=2.02  P.  E. 
M.=4.40P.E. 

♦Numbers  refer  to  cases  as  listed  on  Table  II. 


40  ADENOIDS  AND  DISEASED  TONSILS: 

Is  there,  after  operation,  an  improvement  in  motor  con- 
trol and  attention,  and  a  lessening  of  fatiguability  as  these 
may  be  demonstrated  in  the  tapping  test?  Table  VI  gives  the 
number  of  taps  in  the  first  half  minute  of  tapping  for  both 
groups  before  and  after  the  six  months  interval.  The  test 
group  suffers  an  average  loss  of  2.24  taps,  and  a  median  loss 
of  2.  The  average  loss  of  the  control  group  is  2.33,  and  the 
median  2. 

TABLE  VI 
Gain  in  Grip — 6  Months — 16  Pairs 

N*  Test  Group  (A)  Control  Group  (B) 

Testl         Test  2         Gain  Test  1         Test  2      Gain         A— B 


10 

12.5 

11 

—1.5 

10 

15 

5 

—6.5 

27 

9 

6 

—3 

8 

9 

1 

—4 

1 

13 

12 

—1 

11 

13 

2 

—3 

14 

16 

15 

—1 

22 

24 

2 

—3 

2 

9 

9 

0 

10 

12 

2 

—2 

9 

10.5 

13 

2.5 

16.5 

21 

4.5 

—2 

7 

7 

6.5 

—  .5 

9 

10 

1 

—1.5 

16 

19 

17.5 

—1.5 

10 

10 

0 

—1.5 

3 

12.8 

14.5 

1.7 

14 

15 

1 

.7 

13 

26.5 

28.5 

2 

22 

23 

1 

1 

24 

19 

20 

1 

15 

15 

0 

1 

19 

22 

21 

—1 

15 

12 

—3 

2 

22 

18 

22.5 

4.5 

19.5 

21.5 

2 

2.5 

11 

11 

15 

4 

11.5 

11.5 

0 

4 

21 

16.5 

16.5 

0 

19 

15 

4 

4 

23 

11.5 

15.5 

4 

14.5 

14 

—  .5 

4.5 

Av. 

14.58 

15.22 

.62 

14.19 

15.06 

.875 

—  .24 

M 

0 

1 

—1.0 

75%ile 

3 

2 

2.25 

25%ile 

—1 

0 

—2.5 

Q 

2 

1 

2.38 

P.  E. 

(distribution) 

1.58 

1.02 

2.49 

P.  E. 

(average) 

±.40 

±.26 
Av.=— 

M.=— ; 

±.48 

.50  P.  E. 

2.08  P.  E. 

There  is  practically  no  change  then  in  the  tapping  ability  of 
either  group.  The  high  unreliability  of  the  difference  (P.  E. 
=  =h  3.10)  is  noteworthy.  It  would  seem  that  incidental 
causes  have  a  much  greater  effect  upon  tapping  ability  than 
can  be  demonstrated  as  resulting  from  the  removal  of  ade- 
noids and  tonsils. 

Use  of  the  tapping  test  as  a  measure  of  the  decrease  in  ten- 
dency to  fatigue  similarly  brings  out  no  indication  of  any  im- 
provement in  the  operative  group  of  cases.    The  measure  of 


♦Numbers  refer  to  cases  as  listed  on  Table  II. 


THEIR  EFFECT  UPON  GENERAL  INTELLIGENCE  41 

fatigue  was  taken  as  a  ratio ;  namely,  the  number  of  taps  in 
the  first,  minus  the  number  in  the  second  half  minute  over  the 
number  of  taps  in  the  first  half  minute.  Then,  if  there  is  a 
greater  number  of  taps  in  the  second,  the  ratio  will  be  minus, 
indicating  that  fatigue  effect  is  so  small  as  to  be  overcome  by 
practice  effect.  This  was  a  fact  in  only  four  cases.  Since 
what  we  are  measuring  is  improvement,  the  ratio  for  test  2 
is  subtracted  from  the  ratio  for  test  1  to  find  the  gain  in  over- 
coming fatigue.  Table  VIII  shows  the  average  gain  for  group 
one  to  be  — .0196,  and  the  median  — .045.  That  is,  there  is 
an  average  increase  in  fatiguability  of  .0196  units  and  a  medi- 
an increase  of  .045  with  a  P.  E.  of  ±  .02.  This  increase  in  fa- 
tiguability occurs  also  in  the  control  group,  average  0,  and  Me- 
dian .03  with  P.  E.  of  ±  .03.  The  average  gain  of  test  group 
over  control  group  is  — .02  and  the  median  gain  is  — .015. 
Again  variability  is  relatively  large,  P.  E.  being  1.04,  so  that 
the  median  and  average  gains  are  — .50  P.  E.  and  — .38  P.  E. 
respectively. 

We  may  say,  then,  that  the  capacities  brought  out  by  the 
tapping  test  seem  to  undergo  no  improvement  in  six  months 
after  removal  of  adenoids  and  tonsils. 

The  main  line  of  interest  in  the  present  experiment  lay 
with  the  relation  of  adenoid  and  tonsil  defects  to  general  in- 
telligence. The  results  of  the  two  tests  dealing  more  specific- 
ally with  this  side  of  the  problem  are  here  set  forth.  Table  IX 
shows  the  I.  Q's.  of  the  two  groups  before  and  after  the  six 
months'  interval,  together  with  changes  plus  or  minus  in  I.  Q., 
and  a  comparison  of  the  separate  pairs  in  respect  to  improve- 
ment. 

We  find  that  the  test  group  shows  an  average  gain  in  I.  Q. 
of  2.25  points.  The  median  gain  is  2  points,  the  total  range  18 
points  and  P.  E.  of  the  average  is  ±  .99.  The  control  group 
shows  an  average  gain  very  slightly  higher,  3.25  points,  the 
median  gain  being  3.  The  range  in  this  case  is  32  points,  but 
P.  E.  is  only  ±  .47.  The  average  of  the  compared  gains  of 
separate  pairs  is  — 1.035.  These  numbers  are  so  small  as  to  be 
insignificant.  Actually,  we  may  say  that  the  operative  group 
as  a  whole  showed  no  gain  over  the  control  group.  If  we  ex- 
amine individual  cases  we  find  that  the  greatest  loss  in  I.  Q. 
was  in  the  control  group,  (8  points)  but  the  greatest  gain  (24 
points)  also  appears  in  this  group.    In  the  test  group  11  cases 


42 


ADENOIDS  AND  DISEASED  TONSILS: 


TABLE  VII 


Gain  in  number  of  taps  in  one-half  minute,  21  pairs — right  hand 


N* 

Test  Group  (A) 

Control  Group  (B) 

Testl 

Test  2 

Gain 

Testl 

Test  2 

Gain 

A— B 

14 

190 

138 

—52 

175 

175 

0 

—52 

10 

68 

88 

20 

70 

135 

65 

—45 

23 

150 

141 

—  9 

122 

140 

18 

—27 

1 

135 

120 

—15 

106 

115 

9 

—24 

9 

149 

135 

—14 

144 

150 

6 

—20 

21 

152 

132 

—20 

140 

138 

—  2 

—18 

22 

164 

183 

19 

120 

157 

37 

—18 

24 

157 

142 

—15 

155 

155 

0 

—15 

27 

108 

97 

—11 

115 

112 

—  3 

—  8 

20 

105 

110 

5 

150 

155 

5 

0 

15 

172 

170 

—  2 

140 

137 

—  3 

1 

26 

137 

138 

1 

125 

125 

0 

1 

25 

140 

150 

10 

148 

151 

3 

7 

3 

136 

139 

3 

135 

129 

—  6 

9 

13 

160 

142 

—18 

150 

122 

—28 

10 

18 

133 

135 

2 

100 

84 

—16 

18 

28 

150 

162 

12 

178 

170 

—  8 

20 

8 

113 

110 

—  3 

131 

101 

—30 

27 

11 

125 

98 

—27 

155 

101 

—54 

27 

2 

105 

112 

7 

152 

114 

—38 

45 

17 

90 

150 

60 

125 

121 

—  4 

64 

Av. 

135.19 

132.95 

—  2.24 

136.47 

134.14—  2.33 

.09 

M 

—  2 

—  2 

0 

75%ile 

6.5 

4.5 

16.0 

25%ile 

—15 

—14 

19.5 

Q 

10.75 

9.25 

17.75 

P.  E. 

(distribution) 

12.24 

7.33 

18.09 

P.  E.  ( 

average) 

±2.66 

±1.59 
Av.= 
M.= 

±3.10 
.03  P.  E. 
.0  P.E. 

lost  in  I.  Q.,  as  compared  with  7  in  the  control  group.  Thir- 
teen test  cases  lost  in  comparison  with  their  respective  con- 
trols. Two  gained  equally  with  their  controls,  and  the  re- 
maining thirteen  showed  a  larger  gain.  In  regard  to  the 
three  pairs  taken  from  the  nutrition  class,  number  7  gained 
8  points  and  his  control,  4.  Number  10  lost  a  point  and  his 
control  lost  4,  while  number  11  lost  3  points  with  a  gain  of  1 
point  by  his  control.  So  that  these  cases,  in  spite  of  most  fa- 
vorable conditions,  show  no  consistent  gain  in  I.  Q. 

The  results  of  the  Healy  tests  are  similar.  There  is  a  slight- 
ly higher  average  gain  in  the  control  group.  The  test  group 
contains  eight  cases  which  made  a  poorer  score  at  the  end  of 
the  interval,  the  control  group  six.  The  range  of  gains  is 
from  — 22  to  +44,  or  66  points,  in  the  test  group,  while  in  the 
control  group  the  gains  range  from  — 14  to  -f-41.5  or  55.5 


♦Numbers  refer  to  cases  as  listed  on  Table  II. 


THEIR  EFFECT  UPON  GENERAL  INTELLIGENCE  43 

TABLE  VIII 

Decrease   in   fatigue   in   tapping — Difference   in   rates   of   second   half 
minute  over  first  half  minute.     Sixteen  pairs 


N* 

Test  Group  (A) 

Control  Group  (B) 

Testl 

Test  2        Gain 

Testl 

Test  2 

Gam 

A— B 

13 

—.03 

.05            —.08 

.27 

—.28 

.55 

—.63 

28 

.01 

.11            —.10 

.17 

.04 

.13 

—.23 

20 

.10 

.15            —.05 

.20 

.04 

.16 

—.21 

10 

—.09 

.07             —.16 

.23 

.19 

.04 

—.20 

17 

.01 

.33             —.32 

.07 

.20 

—.13 

—.19 

25 

.09 

.21             —.12 

.09 

.11 

—.02 

—.10 

11 

.28 

.11                .17 

.19 

—.06 

.25 

—.08 

15 

.03 

.08            —.05 

.18 

.16 

.02 

—.07 

22 

.10 

.23            —.13 

.03 

.19 

—.16 

.03 

27 

.15 

.05                .10 

.09 

.03 

.06 

.04 

14 

.09 

.06                .03 

.02 

.06 

—.04 

.07 

18 

.14 

.18            —.04 

.01 

.12 

—.11 

.07 

24 

.13 

.11                .02 

.13 

.35 

—.22 

.24 

26 

.18 

.15                .03 

.16 

.37 

—.21 

.24 

23 

.21 

.04                .17 

.06 

.21 

—.15 

.32 

21 

.27 

.05                .22 

.03 

.20 

—.17 

.39 

Av. 

.104 

.124           —.020 

.121 

.121 

.0 

—.020 

M 

—.045 

—.03 

—.015 

75%ile 

.03 

+.04 

.07 

25%ile 

—.12 

—.16 

—.20 

Q 

.075 

.10 

.135 

P.  E. 

(distribution)                    .09 

.11 

.05 

P.  E. 

(average) 

±.02 

±.03 
Av.=- 

±.04 
-.50  P.  E. 
-.38  P.  E. 

points.  Seventeen  of  the  operative  cases  showed  a  smaller 
gain  than  their  respective  controls.  The  three  pairs  of  cases 
from  the  nutrition  class  show  the  following  gains: — pair  7; 
the  test  case  loses  22  points,  the  control  gains  23  points ;  pair 
10,  test  case  gains  18.5,  but  control  gains  38  points;  pair  11, 
test  case  gains  14  points,  and  control  gains  25.5  points.  From 
this  test  then,  we  can  find  no  general  tendency  for  cases  oper- 
ated on  to  improve  in  intelligence  in  excess  of  improvement 
in  a  control  group  which  was  not  so  treated. 

This  question  presents  itself: — is  there  any  relationship 
between  improvement  in  physical  well-being  as  revealed  in 
weight,  and  improvement  in  intelligence  ?  If,  as  has  been  sup- 
posed, adenoids  and  diseased  tonsils  cause  mental  retardation 
indirectly  through  physical  deprivation,  it  would  seem  as 
though  greater  improvement  in  intelligence  after  operation 
should  accompany  greater  improvement  in  weight,  and  smal- 
ler intelligence  gain  should  accompany  slighter  gain  in  weight. 


♦Numbers  refer  to  cases  as  listed  on  Table  II. 


44 


ADENOIDS  AND  DISEASED  TONSILS: 


In  order  to  determine  whether  this  was  true  for  our  cases,  im- 
provement in  I.  Q.  was  correlated  with  gain  in  weight,  for  the 
test  group.  The  order  of  merit  method  was  used,  and  the 
formula  p  =  1  -~^  where  f  ==  2  sin    (  ^  p).     The  result- 


n(n2-l) 


ing  value  of  r  was  — .10  with  unreliability  of  .226,  calculated 
by  the  formula  <rt.r  —  obt.r  =:^"°!^-  There  is  therefore  no 

V    n 

correlation  between  improvement  in  intelligence  and  gain  in 
weight. 


TABLE  IX 
Improvement  in  I.  Q.,  28  Pairs 


N* 

Test  Group  (A) 

Control  Group  (B) 

Testl 

Test  2 

Gain 

Testl 

Test  2 

Gain 

A— B 

27 

110 

109 

—  1 

72 

96 

24 

—25 

20 

106 

102 

—  4 

118 

131 

13 

—17 

8 

91 

86 

—  5 

98 

104 

6 

—11 

24 

131 

124 

—  7 

89 

92 

3 

—10 

21 

64 

67 

3 

86 

97 

11 

—  8 

3 

94 

91 

—  3 

82 

85 

3 

—  6 

12 

98 

95 

—  3 

98 

101 

3 

—  6 

23 

85 

94 

9 

81 

96 

15 

—  6 

11 

103 

100 

—  3 

101 

102 

1 

—  4 

15 

97 

94 

—  3 

78 

79 

1 

—  4 

18 

98 

98 

0 

90 

94 

4 

—  4 

4 

96 

96 

0 

83 

85 

2 

—  2 

26 

80 

76 

—  4 

90 

88 

—  2 

—  2 

16 

65 

73 

8 

74 

82 

8 

0 

28 

81 

84 

3 

95 

98 

3 

0 

5 

95 

99 

4 

114 

117 

3 

1 

2 

107 

114 

7 

91 

96 

5 

2 

10 

110 

109 

—  1 

104 

100 

—  4 

3 

17 

71 

77 

6 

96 

99 

3 

3 

7 

91 

99 

8 

95 

99 

4 

4 

1 

82 

83 

1 

80 

76 

—  4 

5 

6 

95 

101 

6 

88 

89 

1 

5 

19 

96 

101 

5 

98 

98 

0 

5 

9 

83 

93 

10 

87 

90 

3 

7 

25 

77 

76 

—  1 

145 

137 

—  8 

7 

13 

70 

78 

8 

66 

64 

—  2 

10 

22 

91 

100 

9 

63 

62 

—  1 

10 

14 

96 

107 

11 

140 

137 

—  3 

14 

Av. 

91.53 

93.78 

2.25 

92.93 

96.21 

3.285 

—1.035 

M 

2 

3 

—1 

75%ile 

7 

4 

5 

25%ile 

—3 

—1 

—6 

Q 

5 

2.5 

5.5 

P.  E. 

(distribution) 

5.25 

2.5 

5 

P.  E. 

(average) 

±.99 

±.47 
Av.=i- 
M.  =- 

±1.10 
-.94  P.  E. 
.99  P.  E. 

♦Numbers  refer  to  cases  as  listed  on  Table  II. 


THEIR  EFFECT  UPON  GENERAL  INTELLIGENCE 


45 


TABLE  X 
Improvement  in  Performance  of  Healy  Test,  24  Pairs 


N*  Test  Group  (A) 

Test  1        Test  2        Gain 


Control  Group  (B) 
Test  1         Test  2      Gain 


A— B 


7 

—  6 

—28 

—22 

4.5 

27.5 

23 

—45 

13 

43 

42 

—  1 

—  1.5 

30.5 

—32 

—33 

17 

29.5 

12 

—17.5 

1.5 

15 

13.5 

—31 

16 

7 

25 

18 

1 

42.5 

41.5 

—23.5 

26 

22.5 

7 

—15.5 

56 

61.5 

5.5 

—21.5 

10 

—12 

6.5 

18.5 

27 

65 

38 

—19.5 

19 

57.5 

49 

—  8.5 

—22  ' 

—11 

11 

—19.5 

24 

54.5 

63 

8.5 

31.5 

59.5 

28 

—19.5 

20 

0 

—11 

—11 

30 

35 

5 

—16 

9 

3.5 

10.5 

7 

34 

55 

21 

—14 

11 

—  8 

6 

14 

—29 

—  3.5 

25.5 

—11.5 

16 

49 

47.5 

—  1.5 

30 

37 

7 

—  8.5 

1 

—25 

2 

27 

—50 

—16 

34 

—  7 

22 

48.5 

43.5 

—  5 

34.5 

33.5 

—  1 

—  4 

18 

—13.5 

—12 

1.5 

—32 

—28 

4 

—  2.5 

23 

49.5 

68 

18.5 

4 

25 

21 

—  2.5 

3 

21.5 

22.5 

1 

17 

19 

2 

—  1 

12 

20 

21 

1 

—10 

—12 

—  2 

3 

14 

12.5 

48.5 

36 

—  5 

25.5 

30.5 

6.5 

27 

—25 

15 

40 

2 

27.5 

25.5 

14.5 

2 

28.5 

30 

1.5 

3 

—11 

—14 

15.5 

25 

8 

25 

17 

29.5 

29 

—  .5 

17.5 

21 

20 

32 

12 

70.5 

58.5 

—12 

24 

28 

29.5 

73.5 

44 

64.5 

51.5 

—13 

57 

Av. 

17.29 

24.94 

7.64 

12.12 

25.69 

13.56 

—  5.85 

M. 

4.25 

12.25 

—  7.75 

75%ile 

18 

25.5 

3 

25%ile 

—  5 

—  .5 

—19.5 

Q 

11.5 

13 

11.25 

P.  E. 

(distribution) 

10.6 

10.56 

13.65 

P.  E.  (average) 

±2.16 

±2.16 

±3.05 

Av.=- 

-1.92  P.  E, 

M.=- 

-2.54  P.  E, 

Similarly,  it  might  be  thought  that  the  children  who  had 
suffered  from  the  defects  for  a  comparatively  short  time, 
might  reveal  greater  improvement  in  intelligence  after  six 
months  than  those  who  had  been  afflicted  for  a  longer  space 
of  time.  We  had  no  way  of  knowing  definitely  how  long  the 
defects  had  been  present  in  the  cases  studied.  Roughly, 
though,  we  may  say  that  in  general  the  older  boys  have  had 
defective  tonsils  and  adenoids  for  a  longer  time  than  the 
younger  ones,  and  that  the  older  the  boy,  the  older  the  defect. 
On  this  basis,  if  correlation  of  youth  with  gain  in  I.  Q.  should 
give  a  larger  positive  value  for  r,  we  might  be  justified  in  say- 
ing that  the  younger  boys,  who  have  been  handicapped  for  a 
lesser  period,  show  greater  mental  recuperation  than  their 


♦Numbers  refer  to  cases  as  listed  on  Table  II. 


46  ADENOIDS  AND  DISEASED  TONSILS: 

older  companions.  Such  a  correlation  was  attempted  in  the 
test  group,  correlating  age  at  the  first  test  with  gain  in  I.  Q. 
The  same  methods  and  formulae  were  used  as  in  the  weight 
and  intelligence  comparison,  the  greatest  gain  in  I.  Q.  being 
given  first  position,  and  the  lowest  age.  The  resulting  value 
for  r  was  — .24,  with  an  unreliability  of  .186.  The  relation- 
ship would  appear  to  be  in  the  other  direction  but  it  is  so  small, 
with  an  unreliability  measure  so  large  as  to  be  insignificant. 
Once  more,  then,  we  find  in  our  results  no  correspondence 
between  recency  of  defect  and  quick  mental  recovery. 


TABLE  XI 

Showing  percentile  ratings  of  the  members  of  the  two  groups  at 
beginning  and  end  of  the  six  months'  interval 

the 

Weight 

Height 

Grip 

Tapping 

1 
IC 

.29 
.43 

.44 
.54 

.25 

.27 

.40 

.45 

.47 
.33 

.40 

.47 

.51 
.17 

.33 
.30 

2 
2C 

.04 
.38 

.10 
.55 

.04 
.20 

.11 
.32 

.16 
.25 

.16 
.40 

.16 

.80 

.25 

.28 

3 
3C 

.46 
.65 

.59 
.69 

.32 

.74 

.49 
.81 

.44 
.54 

.56 
.67 

.52 
.51 

.58 
.42 

4 
4C 

.33 

.27 

.44 
.32 

.39 
.51 

.52 

.78 

.16 
.18 

— 

.13 
.19 

— 

5 
5C 

.16 
.50 

.20 
.53 

.18 
.28 

.20 

.47 

.33 

.40 

— 

.23 

.87 

— 

6 
6C 

.12 
.31 

.15 
.40 

.06 
.22 

.10 
.38 

.10 

.27 

— 

.23 

.41 

— 

7 
7C 

.03 
.01 

.07 
.02 

.05 
.03 

.15 
.07 

.07 
.16 

.06 

.24 

.40 
.16 

.27 

8 
8C 

.62 
.18 

.71 
.37 

.63 
.31 

.75 
.40 

.24 
.67 

.72 

.27 
.43 

.23 
.11 

9 
9C 

.31 
.60 

.41 
.65 

.47 
.76 

.53 

.89 

.26 
.76 

.47 
.89 

.71 
.63 

.51 

.78 

10 
IOC 

.26 
.21 

.35 
.22 

.26 
.23 

.43 
.37 

.44 
.24 

.33 

.67 

.01 

.02 

.04 
.51 

11 

lie 

.24 
.08 

.23 
.09 

.25 
.09 

.43 
.17 

.33 
.36 

.67 
.36 

.40 
.86 

.08 
.11 

12 
12C 

.25 
.06 

.40 
.15 

.15 
.02 

.08 

,53 
.04 

.01 

.08 
.12 

.03 

13 
13C 

.95 

.87 

1.00 
.89 

.99 
.93 

1.00 
.96 

.99 

.94 

1.00 
.96 

.90 

.78 

.66 
.36 

THEIR  EFFECT  UPON  GENERAL  INTELLIGENCE  47 


TABLE  XI  (Continued) 

;ings  of  the  members  of 
and  end  of  the  six  month 

Weight  Height  Grip  Tapping 


Showing  percentile  ratings  of  the  members  of  the  two  groups  at  the 
beginning  and  end  of  the  six  months'  interval 


14 
14C 

.49 
.92 

.66 
.93 

.67 
.96 

.74 
.98 

.72 
.93 

.67 
.98 

1.00 
.97 

.57 
.97 

15 
15C 

.56 
.79 

.80 

.68 
.59 

.66 

.70 
.67 

.70 

.95 
.62 

.94 
.54 

16 
16C 

.49 
.34 

.53 

.28 

.74 
.50 

.79 
.54 

.81 
.24 

.77 
.24 

.69 
.69 

.51 

17 
17C 

.53 
.17 

— 

.50 
.15 

— 

.53 
.24 

.11 

.05 
.40 

.78 
.34 

18 
18C 

.57 
.17 

.20 

.38 
.30 

.34 

.33 

.10 

.06 

.45 
.09 

.51 
.03 

19 
19C 

.95 
.38 

.99 
.45 

.94 
.30 

.98 
.37 

.94 
.67 

.88 
.40 

.93 
.09 

.31 

20 
20C 

.13 
.63 

.75 

.37 
.56 

.88 

.33 

.67 

.44 

.16 

.78 

.23 

.86 

21 
21C 

.83 
.67 

.89 
.77 

.84 
.55 

.61 

.76 
.81 

.76 
.67 

.80 
.62 

.44 
.57 

22 
22C 

.85 
.83 

.92 

.81 
.93 

.91 
.97 

.78 
.82 

.95 
.91 

.92 
.33 

.99 
.89 

23 
23C 

.36 
.73 

.74 

.45 

.70 

.82 

.36 
.55 

.70 
.53 

.78 
.36 

.63 
.62 

24 
24C 

.59 
.62 

.69 
.63 

.67 
.59 

.71 

.81 
.67 

.85 
.67 

.89 
.86 

.66 
.86 

25 
25C 

.47 
.73 

.60 

.74 

.57 
.60 

.63 
.64 

.53 

.44 

.91 

.62 
.70 

.78 
.79 

26 
26C 

.74 
.76 

.89 
.81 

.74 
.70 

.85 
.79 

.53 

.84 

.76 

.54 
.40 

.57 
.40 

27 
27C 

.11 
.07 

.12 

.23 
.12 

.23 

.16 
.10 

.04 
.16 

.18 
.30 

.06 
.25 

28 
28C 

.86 

.87 

.90 
.93 

.87 
.83 

.90 
.86 

.97 
.88 

.88 

.78 
.98 

.91 
.94 

48  ADENOIDS  AND  DISEASED  TONSILS: 

TABLE  XI  (Continued) 

Showing  percentile  ratings  of  the  members  of  the  two  groups  at  the 
beginning  and  end  of  the  six  months'  interval 

Possible 
N*  I.  Q.  Healy  Total         Gain     Average 

1  .25  .27  .10  .29  .30  415  .05 

IC  .21  .15  .01  .12  .53  462  .089 


2 
2C 

.84 
.45 

.89 
.51 

.60 
.29 

.66 
.18 

.38 
—.07 

416 
358 

.063 
—.011 

3 
3G 

.49 
.25 

.44 
.32 

.49 
.44 

.51 
.45 

.40 
.30 

328 

287 

.066 
.05 

4 
4C 

.69 
.27 

.59 
.32 

.38 
.71 



.22 

.42 

168 
195 

.073 
.14 

5 
5C 

.53 

.89 

.71 
.90 

.10 

.77 

— 

.42 
.24 

213 
133 

.14 
.08 

6 
60 

.53 
.37 

.77 
.38 

.02 
.04 

— 

.55 
.27 

229 
210 

.183 
.09 

7 
7C 

.45 
.53 

.71 
.71 

.22 
.34 

.07 
.59 

.37 

.74 

478 
393 

.062 

.148 

8 
8C 

.45 

.67 

.34 
.81 

.70 
.33 

.52 

—.50 
.10 

303 
241 

—.125 
.025 

9 
90 

.27 
.35 

.46 
.40 

.23 
.73 

.39 

.89 

.71 

.72 

375 

217 

.118 
.12 

10 
IOC 

.88 
•   .81 

.86 
.73 

.15 

.57 

.35 

.97 

.34 
1.39 

400 
392 

.056 
.218 

11 
lie 

.79 

.77 

.73 
.79 

.20 
.05 

.34 
.23 

.21 

—.44 

379 
379 

.035 
—.073 

12 
12C 

.67 
.67 

.53 

.77 

.47 
.19 

.49 
.15 

—.11 
.19 

161 
208 

— ,036 
.032 

13 
13C 

.09 
.06 

.19 
.05 

.79 
.24 

.78 
.67 

.02 
.06 

129 
178 

.003 
.01 

14 

14C 

.59 
.97 

.84 
.96 

.41 
.21 

.84 
.56 

.69 
.41 

212 
104 

.115 
.068 

15 
15C 

.62 
.19 

.49 
.20 

.38 
.26 

.55 

.79 

.12 
.66 

106 
193 

.04 
.11 

16 
16C 

.05 
.13 

.12 
.25 

.86 
.66 

.82 
.76 

.15 

.24 

205 
313 

.03 
.04 

17 
17C 

.09 
.59 

.17 
.71 

.63 

.27 

.40 
.43 

.66 
.21 

223 

174 

.220 

.053 

18 
18C 

.67 
.40 

.67 
.49 

.13 

.04 

.15 

.07 

.08 
.18 

175 

247 

.027 
.03 

*Numbers  refer  to  cases  as  listed  on  Table  II. 


THEIR  EFFECT  UPON  GENERAL  INTELLIGENCE  49 

TABLE  XI  (Continued) 

Showing  percentile  ratings  of  the  members  of  the  two  groups  at  the 
beginning  and  end  of  the  six  months'  interval 

Possible 
N*  I.  Q.  Healy  Total         Gain     Average 


19 
19C 

.59 
.67 

.69 
.67 

.91 
.11 

.85 
.18 

.16 
.16 

67 
287 

.032 
.027 

20 
20C 

.82 
.91 

.79 
.94 

.25 
.66 

.18 
.75 

—.06 
.20 

177 
65 

—.02 
.066 

21 
21C 

.05 
.34 

.07 
.62 

.47 
.99 

.69 
.92 

—.16 
.46 

209 
157 

—.032 
.077 

22 
22C 

.45 
.03 

.73 
.02 

.84 
.74 

.81 
.72 

.87 

.74 

120 
275 

.174 
.123 

23 
23C 

.32 
.23 

.49 
.59 

.86 
.33 

.98 
.50 

.65 
1.26 

168 
253 

.163 
.21 

24 
24C 

.94 
.38 

.92 
.46 

.88 
.68 

.95 
.93 

—.06 
.54 

89 
179 

—.012 
.09 

25 
25C 

.17 
1.00 

.15 
.97 

.37 
.63 

.55 
.60 

.49 
.53 

280 
134 

.098 
.088 

26 
26C 

.21 
.40 

.15 
.37 

.51 
.90 

.36 
.94 

0 
.04 

226 
184 

0 
.007 

27 
27C 

.88 
.11 

.86 
.59 

.10 
.29 

.43 
.59 

.05 
1.49 

268 
320 

.013 
.25 

28 
28C 

.23 
.53 

.29 
.67 

.63 
.96 

1.00 
.87 

.59 
.24 

153 
83 

.097 
.04a 

Table  XI  expresses  the  results  of  Table  II,  with  the  scores 
given  in  percentile  values.  In  each  test,  the  group  was  taken 
as  composed  of  the  two  scores  of  every  individual — the  total 
number  of  scores  in  tests  and  retests,  eliminating  those  scores 
where  the  other  member  of  the  pair  was  lacking,  or  where  no 
retest  was  given.  Thus  case  number  1  was  just  within  the 
lowest  27%  of  the  group  in  weight  at  the  first  weighing,  but 
had  advanced  to  the  44  percentile  at  the  second.  In  height  he 
gained  from  the  25  percentile  to  the  40  percentile.  His  total 
gain  in  all  tests  is  30  percentile  out  of  a  possible  415,  and  the 
average  gain  is  .05.  The  reader  may  see  by  scanning  the  table 
that  the  gains  in  the  test  group  are  practically  equalled  by 
those  in  the  control  group.  There  seems  to  be  no  consistent  re- 
lationship between  a  low  score  in  the  first  test  and  a  large  gain. 
This  is  true  even  though  the  method  of  calculation  tends  to 
minimize  gains  at  the  high  end  of  the  group,  and  losses  at  the 


50  ADENOIDS  AND  DISEASED  TONSILS: 

low  end.  In  table  XII  this  may  be  seen  more  clearly  in  respect 
to  I.  Q.  and  the  results  for  all  the  tests  taken  together  with  the 
I.  Q.  weighted  by  being  counted  twice.  A  large  possible  gain 
indicates  that  the  score  at  the  first  testing  was  low,  and  vice 
versa.  Considering  I.  Q.  values,  the  largest  possible  gain  in  the 
test  group  was  95  per  cent  of  the  group.  This  occurred  twice, 
in  one  case  the  actual  gain  being  7%  of  the  group  and  in  the 
other  2%.  In  the  control  group,  the  largest  possible  gain 
was  97%  of  the  group,  but  actually  this  case  fell  1%  of  the 
group.    If  we  correlate  possible  gain  with  actual  gain  for  each 

group,  using  the  formula  r  =  2sin  (-f-  p)  when  p  =  1 ^Sr 

we  get  a  coefficient  of  correlation  .36  in  the  test  group,  and  .19 

TABLE  XII 

Showing  gains  in  percentile  rating  for  I.  Q.,  and  for  a  total  of  all  the 
tests  with  I.  Q.  weighted  by  being  counted  twice. 

I.  Q.  Total 


1st 
P.R. 

2d 
P.R. 

A 

possible 
gain 

B 

actual 
gain 

possible 
gain 

actual 
gain 

Av.  Gain 

1 

IC 

25 
21 

27 
15 

75 
79 

2 
—  6 

415 
462 

30 
53 

5 

8.9 

2 
2C 

84 
45 

89 
51 

16 
55 

5 
6 

416 
358 

38 

—  7 

6.3 
—  1.1 

3 
3C 

49 
25 

44 
32 

51 

75 

—  5 

7 

328 

287 

40 
30 

6.6 
5 

4 
4C 

59 
27 

59 
32 

41 
73 

0 
5 

168 
195 

22 

42 

7.3 

14 

5 
5C 

53 

89 

71 
90 

47 
11 

18 

1 

213 
133 

42 
24 

14 
8 

6 
6C 

53 
37 

77 
38 

47 
63 

24 

1 

229 
210 

55 
27 

18.3 
9 

7 
7C 

45 
53 

71 
71 

55 

47 

26 
18 

478 
393 

37 

74 

6.2 
14.8 

8 
8C 

45 
67 

34 
81 

55 
33 

—11 
14 

203 
241 

—50 
10 

—12.5 
2.5 

9 
9C 

27 
35 

46 
40 

73 
65 

19 
5 

375 
217 

71 

72 

11.8 
12 

10 
IOC 

88 
81 

86 
73 

12 

19 

—  2 

—  8 

400 
392 

34 
139 

5.6 
21.8 

11 

lie 

79 

77 

73 

79 

21 
23 

—  6 
2 

379 
379 

21 

—44 

3.5 
—  7.3 

THEIR  EFFECT  UPON  GENERAL  INTELLIGENCE  51 

TABLE  XII   (Continued) 

Showing  gains  in  percentile  rating  for  I.  Q.,  and  for  a  total  of  all  the 
tests  with  I.  Q.  weighted  by  being  counted  twice. 
I.  Q.  Total 

A  B 


1st 
P.R. 

2d 
P.R. 

possible 
gain 

actual 
gain 

possible 
gain 

actual 
gain 

Av.  Gain 

12 
12C 

67 
67 

53 

77 

33 
33 

—  6 
10 

161 
208 

—11 
19 

—  3.6 
3.2 

13 
13C 

9 
6 

19 
5 

91 
94 

10 
—  1 

129 
178 

2 
6 

.3 

1 

14 
14G 

69 
97 

84 
96 

41 
3 

25 
—  1 

212 
104 

69 
41 

11.5 
6.8 

15 
150 

62 
19 

49 
20 

38 
81 

—13 
1 

106 
193 

12 
66 

4 
11 

16 
16G 

5 
13 

12 
26 

95 
87 

7 
12 

205 
213 

15 
24 

3 

4 

17 
17C 

9 
69 

17 
71 

81 
41 

8 
12 

223 

174 

66 
21 

22 
5.3 

18 
18C 

67 
40 

67 
49 

33 
60 

0 
9 

175 

247 

8 
18 

2.7 
3 

19 
190 

69 
67 

69 
67 

41 
33 

10 
0 

67 

287 

16 
16 

3.2 
2.7 

20 
20O 

82 
91 

79 
94 

18 
9 

—  3 
3 

177 
65 

—  6 
20 

—  2 
6.6 

21 
210 

6 
34 

7 
62 

95 
66 

2 

28 

209 
157 

—16 

46 

—  3.2 

7.7 

22 
220 

45 
3 

73 
2 

55 

97 

28 

—  1 

120 
275 

87 

74 

17.4 
12.3 

23 
230 

32 
23 

49 
59 

68 

77 

17 
36 

168 
253 

65 
126 

16.3 
21 

24 
240 

94 
38 

92 
46 

6 
62 

—  2 
8 

89 
179 

—  6 

54 

—  1.2 
9 

25 
250 

17 
100 

15 
97 

83 
0 

—  2 

—  3 

280 
134 

49 
53 

9.8 
8.8 

26 
260 

21 
40 

15 
37 

79 
60 

—  6 

—  3 

226 
184 

0 
4 

0 

.7 

27 
270 

88 
11 

86 
59 

12 
89 

—  2 

48 

268 
320 

5 

148 

1.3 
25 

28 
280 

23 
53 

29 
67 

77 
47 

6 
14 

153 
83 

59 
24 

9.7 
4.8 

52  ADENOIDS  AND  DISEASED  TONSILS: 

in  the  control  group.  With  the  small  number  of  cases  involved 
the  probable  error  is  too  great  to  allow  either  of  these  measures 
as  indicative  of  relationship.  We  may  say,  then,  that  there  is 
no  definite  tendency  for  those  of  low  I.  Q.  to  improve  in  six 
months  after  operation  to  a  greater  degree  than  those  of  high- 
er I.  Q. 

Finally,  in  order  to  compare  the  results  of  the  various 
tests,  the  measures  of  the  gains  of  the  test  group  in  excess  of 
the  control  were,  for  each  test,  expressed  in  terms  of  P.  E. 
The  averages  and  medians  of  these  measures  are  collected  in 
Table  XIII.  They  show  a  very  slight  tendency  toward  gain 
in  weight,  height,  and  weight-height-age  relationship ;  neither 
improvement  nor  loss  in  grip,  tapping  f  atigueability  and  I.  Q., 
and  a  rather  curious  tendency  to  loss  in  the  Healy  scores.  This 
latter  is  very  probably  not  a  true  measure  since  performance 
in  the  Healy  Picture  Completion  test  shows  a  rather  high 
variability,  and  the  cases  are  so  few  as  to  make  the  influence 
of  single  very  high  or  low  scores  unduly  great. 

TABLE  XIII 

Showing  improvement  in  various  tests  of  operative  group  over  and 
above  such  improvement  in  control  group.  Expressed  in  Terms  of  P.E. 

Weight  Height  Height-  Grip  Tapping  Tapping  I.  Q.      Healy 

Weight  fatigue 

P.E.     P.E.    P.E.      P.E.     P.E.      P.E.      P.E.      P.E. 

Average  2.85  1.00  2.02  —.50  .03  —.50  —  .94  —1.92 
Median  2.80       1.25         .55      —.83       .32      —.50  0  —2.54 


CHAPTER  IV 

MEASUREMENT  OF  IMPROVEMENT  AFTER  A 
SECOND  INTERVAL  OF  SIX  MONTHS 

In  view  of  the  fact  that  otie  of  the  experimenters*  found 
improvement  in  school  work  when  her  study  was  extended 
to  cover  a  second  time  interval  after  operation,  it  was  deemed 
advisable  to  similarly  extend  the  present  investigation  in  or- 
der to  determine  whether  our  operated  cases  showed  any  im- 
provement after  twelve  months.  To  this  end,  the  fifty-six 
children  composing  the  final  groups  of  the  first  study,  were 
sought  after  a  second  interval  of  about  six  months.  Conditions 
made  it  impossible  to  give  all  the  retests  exactly  twelve  months 
from  the  time  of  the  operation.  As  a  matter  of  fact,  the  period 
ranges  from  ten  to  seventeen  months.  An  effort  was  made  to 
keep  the  interval  between  tests  equal  for  the  two  members  of 
a  given  pair. 

The  same  tests  were  given  as  in  the  first  study.  About 
half  of  the  testing  was  done  by  one  of  the  former  examiners, 
but  she  was  obliged  to  turn  the  work  over  to  another  before  it 
had  been  completed.  The  second  examiner  was  highly  recom- 
mended, and  had  had  training  and  practical  experience  in  the 
giving  of  tests.  She  was  instructed  in  the  methods  which  had 
been  employed  previously,  so  that  conditions  were  as  far  as 
possible  kept  constant. 

The  results  of  the  tests  are  collected  in  Table  XIV.  In  the 
first  column  is  given  the  length  of  the  time  interval  for  each 
case.  It  may  be  seen  that  the  final  group  was  composed  of 
forty-two  children,  forming  twenty-one  pairs.  There  were 
fifteen  pairs  which  received  a  second  rating  in  weight;  thir- 
teen in  height;  thirteen  in  grip;  fifteen  in  tapping,  eleven  in 
fatigue  as  shown  by  tapping,  twenty-one  in  I.  Q.,  and  eighteen 
in  the  Healy  Test.  These  numbers  while  they  are  smaller 
than  we  could  wish,  would  seem  to  be  great  enough  to  indi- 


*A.  H.  Mac  Phail,  Adenoids  and  Tonsils:  A  study  showing  how  the 
Removal  of  Enlarged  or  Diseased  Tonsils  Affects  a  Child's  Work  in 
School.    Ped.  Sem.,  June,  1920,  pp.  188-194. 

53 


54  ADENOIDS  AND  DISEASED  TONSILS: 

TABLE  XIV 

Results  of  the  Tests  after  an  Interval  of  from  10  to  17  Months 

N*        Mos.  Weight  Height  Grip 

Test    1      Tests      Testl  Test  3      Test  1        Test  3 


1 

10 

15 
15 

50.4 
53.5 

63.5 
62.8 

46 
46.4 

49.7 
49.7 

13 
11 

18 
15 

2 
20 

15 
17 

40.9 
52.3 

47.9 
65.5 

42.6 
45.2 

45.9 
49.8 

9 
10 

10 
15 

3 
30 

16 
14 

55 
61.5 

67.5 
57.8 

47 
51.7 

50.2 
54 

12.8 
14 

13 
14.5 

4 
40 

13 
13 

51.1 
49.4 

60.2 
54.2 

47.5 
48.9 

50.5 
50.8 

9 
9.5 

— 

7 
70 

14 
12 

39.9 
38.4 

45.8 
42.1 

42.9 
41.9 

45.6 
43.7 

7 
9 

6 
14 

8 
80 

11 
11 

60.8 
45.4 

69.2 
57.9 

50.8 
36.8 

52.3 

48.7 

10 
15 

__ 

10 
lOO 

11 
11 

48.9 
47.1 

56.7 
51.8 

46.1 
45.6 

48.6 
48.1 

12.5 
10 

12 
12 

11 
110 

12 
12 

47.8 
41.6 

55 
47 

45.8 
43.6 

49.5 
46.8 

11 
11.5 

11 
7.5 

12 
120 

12 
11 

48 
41 

66.5 
69.6 

44.8 
41.5 

__ 

14 
6 

.  .., 

13 
130 

12 

12 

90 
74.7 

112 

88 

61.3 
56.8 

61.8 
60.0 

26.5 
22 

28.5 
27 

14 
140 

12 
12 

56 
81.9 

66 
98 

51 
57.9 

53.3 
59.5 

16 
22 

17 
22.6 

15 
150 

12 
10 

57.5 
67.2 

__ 

51.1 
50.1 

— 

15.5 
15 

1 

16 
160 

12 
11 

56 
51.2 

60.3 
55 

51.6 

48.7 

53.5 
50.1 

19 
10 

18.5 
10 

18 
180 

12 
11 

58.2 
45.3 



47.3 
46.7 



18 
8 

— 

19 
190 

12 
11 

90 
52.4 

108 
59 

57.7 
46.7 

60.5 
48 

22 
15 

20 
18 

20 
20O 

12 
11 

44.2 
61.3 



47.2 
49.6 

— . 

11 
15 

— 

21 
210 

12 
10 

70.7 
62.4 

85.5 
69.2 

54.1 
49.6 



16.5 
19 

15 
17 

23 
230 

12 
11 

51.7 
64.1 

— 

47.8 
51.4 



11.5 
14.5 

15 
16 

27 
270 

12 
11 

43.7 
41 



45.4 
44.6 



9 
8 

6 
9 

28 
280 

12 
11 

71.3 

74.2 

78.5 
85.8 

54.9 
53.4 

56.3 
55.9 

23.5 
21 

— 

♦Numbers  refer  to  cases  as  listed  on  Table  II. 


THEIR  EFFECT  UPON  GENERAL  INTELLIGENCE 


55 


TABLE  XIV  (Continued) 
N*  Tapping  I.  Q.  Healy 

Testl  Tests  (1)  (3)  (1)  (3) 

1        135  142  82  93  —25  11 

IC     106  134  80  85  —50  11 


2 

105 

135 

107 

113 

2C 

152 

139 

91 

86 

3 

136 

144 

94 

91 

3C 

135 

135 

82 

96 

4 

103 



96 

111 

4C 

109 

— 

83 

102 

7 

125 



91 

93 

7C 

105 

— 

95 

112 

8 

113 

128 

91 

92 

8C 

131 

121 

98 

111 

10 

68+  74 

145+106 

110 

116 

IOC 

70+  74 

148+124 

104 

107 

11 

125+  90 

120+125 

103 

102 

lie 

155+125 

102+112 

101 

95 

12 

98+  69 



98 

86 

12C 

102 

— 

98 

90 

13 

160+165 

176+187 

70 

61 

13C 

150+109 

188+174 

66 

60 

14 

190+172 

228+215 

96 

102 

14C 

175+152 

165+186 

140 

138 

15 

172+167 

192+186 

97 

97 

15C 

140+115 

145+133 

78 

98 

16 

145+131 



65 

74 

16C 

145+  99 

— 

74 

81 

18 

133+115 

126+145 

98 

101 

18C 

100+  99 

108+  92 

90 

92 

19 

168+136 



96 

97 

19C 

100+115 

— 

98 

90 

20 

105+115 

122+118 

106 

116 

20C 

150+120 

154+154 

118 

140 

21 

152+111 

154+155 

64 

66 

21C 

140+136 

174+150 

86 

93 

23 

150+119 

157+157 

85 

80 

23C 

122+115 

141+141 

81 

88 

27 

108+  92 

114+  95 

110 

112 

27C 

115+105 

101+118 

72 

98 

28 

150+148 

176+168 

81 

83 

28C 

178+148 

172+157 

95 

94 

28.5 
3 

21.5 
17 

8.5 
33 

-  6 

4.5 

32.5 

4 

-12 
27 

-  8 
-29 

20 
-10 

43 

-  1.5 

12.5 

-  5 

7 
1 

49 
30 

-13.5 
-32 

57.5 
-22 

0 
30 

20 
70.5 

49.5 
4 

-25 
2 

29.5 
64.5 


24.5 
19.5 

15.5 
25.5 


16 
11 


11 
48.5 

15.5 
-20 

1 
41.5 

62.5 
21.5 

77 
48.5 

19 
54.6 

79 
45.5 

13.5 
-35 

60.5 
-15 

55 

48.5 

38 

88 

62.5 
64 

25.5 
39.5 

77.5 
83.5 


56 


ADENOIDS  AND  DISEASED  TONSILS: 


cate  any  very  consistent  tendency  toward  improvement.  The 
question,  whether  or  not  the  results  are  affected  by  the  differ- 
ences in  time  interval,  will  be  considered  later. 

In  weight,  the  test  group  showed  an  average  gain  of  11.013 
pounds,  with  a  median  of  9.1  (Table  XV).  The  average  gain 
of  the  control  group  was  9.113  pounds  and  the  median  6.8. 
The  gains  in  the  test  group  are  less  variable  than  those  of  the 
control.  The  average  of  the  gains  of  the  test  group  in  excess 
of  those  of  the  control  is  1.9  pounds,  and  the  median  is  2.2 
pounds;  while  the  unreliability  of  the  difference  is  +  1.46. 
The  average,  then,  is  only  1.30  P.  E.  and  the  median  1.51  P.  E. 

If  we  turn  to  Table  III  and  compare  the  results  there  set 
forth  with  the  results  at  the  end  of  the  second  period,  we  find 
the  gains  of  the  test  group  exceed  those  of  the  control  in  the 
following  manner. 


TABLE  XV 

Weight, 

Second  Retests,  15  Pairs 

N* 

Test  Group  (A) 

Control  Group  (B) 

Test  1         Test  3 

Gain 

Test  1        Test  3      Gain 

A— B 

12 

48             66.5 

18.5 

41              69.6 

28.6 

—10.1 

2 

40.9           47.9 

7 

52.3           65.5 

13.2 

—  6.2 

14 

56              66 

10 

81.9           98 

16.1 

—  6.1 

28 

71.3           78.5 

7.2 

74.2           85.8 

11.6 

—  4.4 

8 

60.8           69.2 

8.4 

45.4           57.9 

12.5 

—  4.1 

16 

56              60.3 

3,7 

51.2           55 

3.8 

—     .1 

11 

47.8           55 

7.2 

41.6           47 

5.4 

1.8 

7 

39.9           45.8 

5.9 

38.4           42.1 

3.7 

2.2 

10 

48.9           56.7 

7.8 

47.1           51.8 

4.7 

3.1 

1 

50.4           63.5 

13.1 

53.5           62.8 

9.3 

3.8 

4 

51.1           60.2 

9.1 

49.4           54.2 

4.8 

4.3 

21 

70.7           85.5 

14.8 

62.4           69.2 

6.8 

8 

13 

90            112 

22 

74.7           88 

13.3 

8.7 

19 

90            108 

18 

52.4           59 

6.6 

11.4 

3 

55              67.5 

12.5 

61.5           57.8 

—  3.7 

16.2 

Av. 

58.45         69.50 

11.01 

55.13         63.58 

9.11 

1.9 

M 

9.1 

6.8 

2.2 

75%ile 

13.52 

12.67' 

5.22 

25%ile 

7.15 

4.47 

—  4.07 

Q 

3.18 

4.1 

4.65 

P.  E.   (distribution) 

3.81 

4.19 

6.1 

P.  E.   (average) 

±1.00 

±1.07 

±1.46 

Av.= 

:1.30  P.  E, 

M.= 

:1.51P.E, 

6  months 

12  months 

Average 

of  gains  in  test  group  in 

excess  of  control 

1.37 

1.9 

Median 

1.2 

2.2 

P.  E.  of 

difference 

±.48 

±1.46 

Average 

in  terms  of  P.  E. 

2.85 

1.30 

Median  i 

in  terms  of  P.  E. 

2.80 

1.51 

♦Numbers  refer  to  cases  as  listed  on  Table  II. 


THEIR  EFFECT  UPON  GENERAL  INTELLIGENCE  57 

After  a  twelve  months*  interval,  therefore,  the  actual  av- 
erage and  median  gains  are  slightly  larger  than  after  the 
first  six  months,  but  the  variability  is  very  much  greater. 
Therefore,  when  expressed  in  terms  of  P.  E.,  the  gains  are 
smaller.  One  of  the  test  group  cases  (No.  13)  who  had  gained 
8  pounds  after  six  months,  gained  14  pounds  in  the  second 
period  of  six  months,  making  a  total  gain  of  22  pounds.  This 
gain  is  exceeded,  however,  by  one  in  the  control  group  (No. 
12)  who  gained  3.5  pounds  in  six  months,  and  25.1  pounds 
more  in  the  ensuing  five  months.  This  is  certainly  an  enor- 
mous gain  for  five  months,  under  any  circumstances. 
Turning  to  Table  XIV  we  find  no  corresponding  gain  in  I.  Q. 
for  this  child.    Indeed  there  is  a  loss  of  five  points. 

Other  children  in  the  test  group  who  made  large  gains, 
were  case  12,  with  a  gain  of  18.5  pounds  after  twelve  months, 
compared  with  4.5  pounds  after  six  months ;  case  19,  gain  of 
6.3  pounds  after  first  six  months,  and  18  pounds  after  12 
months;  case  21,  whose  gain  after  the  first  period  was  5.8 
pounds,  but  who  gained  14.8  pounds  after  twelve  months. 
In  these  cases  the  gain  in  the  second  period  greatly  exceeds 
that  for  the  first. 

TABLE   XVI 
Height,  Second  Retests,  13  Pairs 


N* 

Test 

Group  (A) 

Control  Group  (B) 

Testl 

Test  3 

Gain 

Test  1        Test  3 

Gain 

A— B 

18 

61.3 

61.8 

.5 

56.8          60 

3.2 

—2.7 

2 

42.6 

45.9 

3.3 

45.2           49.8 

4.6 

—1.3 

28 

54,9 

56.3 

1.4 

53.4           55.9 

2.5 

—1.1 

8 

50.8 

52.3 

1.5 

46.8           48.7 

1.9 

—  .4 

10 

46.1 

48.6 

2.5 

45.6           48.1 

2.5 

.0 

1 

46 

49.7 

3.7 

46.4           49.7 

3.3 

.4 

11 

45.8 

49.5 

3.7 

43.6           46.8 

3.2 

.5 

16 

51.6 

53.5 

1.9 

48.7           50.1 

1.4 

.5 

14 

51 

53.3 

2.3 

57.9           59.5 

1.6 

.7 

3 

47 

50.2 

3.2 

51.7           54 

2.3 

.9 

7 

42.9 

45.6 

2.7 

41.9           43.7 

1.8 

.9 

4 

47.5 

50.5 

3 

48.9           50.8 

1.9 

1.1 

19 

57.7 

60.5 

2.8 

46.7             4.8 

1.3 

1.5 

Av. 

49.63 

52.17 

2.5 

48.74         51.16 

2.42 

.08 

M 

2.7 

2.3 

.5 

75%ile 

3.15 

2.85 

.85 

25%ile 

1.6 

1.75 

.92 

Q 

.775 

.65 

.885 

P.  E. 

(distribution) 

.66 

.78 

.82 

P.  E. 

(average) 

±.18 

±.22 
Av.=: 

M.=: 

±.28 
.29  P.  E. 
1.79  P.  E. 

♦Numbers  refer  to  cases  as  listed  on  Table  II. 


58  ADENOIDS  AND  DISEASED  TONSILS: 

In  weight,  then,  the  mean  gain  of  the  test  group  over  and 
above  the  control  continues  to  increase  through  the  second 
period  of  six  months.  The  variability,  however,  increases 
enormously,  which  fact  is  due  possibly  to  varying  conditions 
which  may  enter  in  during  the  longer  period  to  affect  the 
health  and  thus  lessen  the  gain  of  some  of  the  children. 

In  order  to  determine  whether  the  slight  inequalities  in 
interval  length  have  any  considerable  effect  on  the  results,  we 
have  calculated  the  relation  between  the  length  of  interval 
and  amount  of  improvement.  The  coefficient  of  correlation 
by  the  method  of  rank  differences  is  equal  to  .03.  The  small 
number  of  cases  renders  the  unreliability  of  correlation  very 
great,  but  we  can  at  least  say  that  there  is  no  consistent  re- 
lationship between  improvement  and  time  interval,  within  the 
narrow  limits  here  set.  We  are  probably  justified  in  taking 
twelve  months  as  the  interval,  since  such  was  the  case  in  eight 
out  of  the  fifteen  test  cases,  while  the  greatest  variation  above 
this  made  was  four  months,  and  below  it,  one  month. 

The  gains  in  height  after  twelve  months  are  shown  in  Table 
XVI.  The  average  gain  of  test  group  in  excess  of  control,  is 
only  .08  inches,  and  the  median  .5  inches.  Variability  is  about 
the  same  as  at  the  end  of  six  months,  P.  E.  ±  .28.  The  aver- 
age is  only  .29  P.  E.,  but  the  median  is  a  little  larger,  1.79 
P.  E.  If  these  measures  are  compared  with  the  results  after 
the  first  period,  we  have : 

6  months  12  months 
Average  of  gains  of  test  group  in  excess  of  control  .16  .08 

Median  of  gains  of  test  group  in  excess  of  control       .2  .5 

P.  E.  of  difference  .16  .28 

Average  in  terms  of  P.  E.  1.00  .29 

Median  in  terms  of  P.  E.  1.25  1.79 

There  seems  to  be  little  gain  in  height  after  the  first  period. 
Test  cases  1  and  11  each  show  a  gain  of  3.7  inches  after 
fifteen  and  twelve  months  respectively,  compared  with  gains 
after  six  months  of  1.6,  and  1.9  inches.  But  case  2  in  the 
control  group,  makes  still  greater  comparative  gain,  +1.8 
inches  after  six  months  and  4.6  inches  after  seventeen  months, 
In  this  case  there  are  almost  six  additional  months  for  the 
child  to  grow,  which  may  account  for  the  larger  gain.  Con- 
trol case  1,  however,  may  be  compared  with  his  partner, 
mentioned  above,  since  the  interval  between  tests  was  the 
same  for  both.  This  boy  grew  1.4  inches  in  six  months,  and 
3.3  inches  after  15  months.    This  is  practically  equal  growth 


THEIR  EFFECT  UPON  GENERAL  INTELLIGENCE  59 

with  test  case  1.  Control  case  11  also  shows  relatively  great 
growth  during  12  months,  +3.2  inches,  whereas  the  growth 
in  six  months  was  only  1.3  inches.  Out  of  the  test  group,  7 
cases  gained  more  in  the  first  period  of  six  months,  than  in 
the  second,  while  only  6  gained  more  in  the  second  than  in 
the  first.  Of  the  control  group,  7  cases  made  more  than  half 
of  their  total  gain  during  the  second  six  months  of  the  total 
twelve  months'  period.  Since  this  is  true,  it  seems  likely  that 
whatever  increase  in  growth  we  find  during  the  second  half 
of  the  twelve  months'  interval,  may  be  explained  by  in- 
cidental causes,  and  that  so  far  as  actual  gain  in  height  is 
considered,  there  is  no  further  effect  from  the  operations, 
after  six  months. 

As  was  mentioned  in  the  previous  chapter,  height  and 
weight  are  of  less  significance  when  considered  alone,  than 
when  taken  in  relation  to  each  other  and  to  the  age  of  the 
individual.  The  gain  in  this  weight-height-age  relationship 
following  upon  operation  for  adenoids  and  tonsils,  will  be 
considered  in  the  same  manner  as  were  weight  and  height 
gains.    We  have,  then: 


TABLE 

XVII 

Height-Weight  Relationship, 

Second 

Retests, 

13  Pairs 

Showing  changes 

in  per  cent 

over  or 

underweight  after 

12  months' 

interval 

I 

N* 

Test  Group  (A) 

Control  Group  (B) 

Testl 

Tests 

Change       Test  1 

Test  2 

Change 

A— B 

8 

—  1 

+  7 

+  8 

—13 

0 

+13 

—  5 

16 

—16 

—17 

—  1 

—13 

—  9 

+  4 

—  5 

11 

—  3 

—  6 

—  3 

—  9 

—10 

—  1 

—  2 

14 

—13 

—  6 

+  7 

—  5 

+  4 

+  9 

—  2 

19 

+  6 

+10 

+  4 

+  1 

+  7 

+  6 

—  2 

28 

—  7 

—  4 

+  3 

0 

+  5 

+  5 

—  2 

10 

—  1 

0 

+  1 

—  6 

—  6 

0 

+  1 

7 

—  8 

—  8 

0 

—  7 

—  9 

—  2 

+  2 

2 

—  8 

—  4 

+  4 

+  9 

+10 

+  1 

+  3 

4 

—  7 

—  4 

+  3 

—15 

—15 

0 

+  3 

1 

0 

+  6 

+  6 

+  8 

+  5 

—  3 

+  9 

13 

—13 

+  6 

+19 

—11 

—12 

—  1 

+20 

3 

+  6 

+13 

+  7 

—  5 

—20 

—15 

+22 

Av. 

—  5 

—    .54 

4.46 

—  5.08 

3.85 

1.23 

3.23 

M 

4 

—2 

6 

75%ile 

6.75 

2.75 

3 

25%ile 

—2.50 

2.75 

—  2 

Q 

4.625 

2.75 

2.50 

P.  E. 

(distribution) 

2.54 

3.23 

5.23 

P.  E. 

(average 

±.71 

±.90 

±1.15 

Av.=2.81  P.  E. 

M.  =5.22  P.  E. 

♦Numbers  refer  to  cases  as  listed  on  Table  II. 


60  ADENOIDS  AND  DISEASED  TONSILS: 

6  months  12  months 
Average  of  gains  of  test  group  in  excess  of  control     1.83  3.23 

Median  of  gains  of  test  group  in  excess  of  control    4.00  6 

P.  E.  of  difference 91  1.15 

Average  in  terms  of  P.  E 2.02  2.81 

Median  in  terms  of  P.  E 4.40  5.22 

The  mean  of  the  actual  gains  in  the  second  period  ex- 
ceeds that  of  the  first.  Again  the  second  group  of  results 
is  more  variable,  decreasing  the  reliability.  There  seems, 
however,  to  be  a  definite  increase  in  the  net  gain  of  the  test 
group  during  a  second  six  months'  period.  Some  individual 
cases  may  be  cited.  The  greatest  gain  after  six  months  is 
8  units  in  the  test  case,  matched  by  an  equal  gain  of  8  units 
in  the  control  group.  After  twelve  months,  the  test  group 
shows  one  gain  of  19  units,  the  highest  gain  in  the  control 
group  being  13.  Six  cases  in  the  test  group,  and  13  in  the 
control  had  lost  at  the  end  of  six  months,  but  after  twelve 
months,  all  but  2  of  the  test  cases  showed  a  gain,  and  all 
but  5  of  the  controls.  In  10  test  cases  out  of  the  total  13, 
more  than  half  of  the  gain  occurred  during  the  second  six 
months.  In  the  control  group,  six  of  the  cases  made  more 
than  half  of  their  gain  during  the  second  six  months,  and  the 
second  interval  gains  of  the  other  7  cases  exceeded  the  50 
per  cent  mark  by  so  little  that  they  may  be  accounted  for  by 
chance. 

These  results  seem  to  indicate  a  slight  but  actual  increase 
in  the  net  gain  of  the  test  group  during  the  second  six  months 
of  the  experiment,  and  an  accompanying  growth  in  the  vari- 
ability of  these  gains. 

It  will  be  remembered  that  the  results  described  in  the 
previous  chapter  show  no  gain  in  strength  of  grip  as  a  re- 
sult of  operation.  Comparison  of  the  13  cases  tested  after 
the  second  interval,  with  the  16  cases  at  the  end  of  the  first, 
gives  results  as  follows : 

TABLE  XVIII 
Gain  in  Grip,  Second  Retest,  13  Pairs 

N*                   Test  Group  (A)  Control  Group  (B) 

Testl  Test  2         Gain  Test  1  Test  2  Gain  A— B 

7  7                  6—1  9  14  5  —6 

19  22               20           —2  15  18  3  —5 

2  9      10      1  10  15  5  —4 

27  9       6—3  8  9  1—4 

13  26.6     28.5     2  22  27  5  —3 

10  12.5     12     —  .5  10  12  2  —2.5 

16  19      18.5    —  .5  10  10  0  —  .5 


THEIR  EFFECT  UPON  GENERAL  INTELLIGENCE  61 

TABLE  XVIII  (Continued) 

N*                   Test  Group  (A)  Control  Group  (B) 

Testl        Test  2        Gain  Test  1        Test  2     Gain  A— B 

3            12.5            13                 .5  14               14.5            .5  0 

14             16                17               1  22                22.5             .5  .5 

21            16.5            15           —1.6  19               17         —2  .6 

1            13               18               5  11               15             4  1 

23            11.5            15               8.5  14.5            16             1.5  2 

11             11               11               0  11.5              7.6      —4  4 

Av.          14.27          14.61            .34  13.54          15.19         1.65  —1.31 

M                                                 0  1.5  —1.5 

75%ile                                         1.25  3.75  .62 

25%ile                                     —1.38  .12  —  .4 

Q                                                  1.31  1.81  .51 

P.    E.    (distribution)              1.34  1.65  2.31 

P.  E.   (average)                      ±JS7  ±.46  ±.59 

Av.=— 2.22  P.  E. 
M.=— 2.54P.E. 

6  months  12  months 
Average  of  gains  of  test  group  in  excess  of  control  —  .24  — 1.31 

Median  of  gains  of  test  group  in  excess  of  control  — 1.00  — 1.50 

P.  E.  of  difference    ±  .48  ±  .59 

Average  in  terms  of  P.  E —  .50  —2.22 

Median  in  terms  of  P.  E — 2.08  — 2.54 

The  greatest  gain  in  the  test  group  after  twelve  months  is 
5  Kg.  (Case  1).  During  the  first  six  months  this  case  lost 
1  Kg.  There  are  two  gains  of  5  Kg.  in  the  control  group. 
Of  these  two  (cases  7  and  13)  had  gained  1  Kg.  during 
the  first  interval  and  another  (case  2)  2  Kg.  The  greatest 
loss  in  the  test  group  after  the  twelve  months'  period  was 
3  Kg.,  by  case  27,  which  had  already  lost  this  amount  at 
the  end  of  six  months.  The  greatest  loss  in  the  control 
group  was  suffered  by  case  11,  a  loss  of  4  Kg.,  all  in  the 
second  period.  After  the  first  period,  9  out  of  16  cases  in 
the  test  group  gained  in  strength  of  grip,  and  13  in  the 
control  group.  After  the  second  period,  the  test  cases  show- 
ing gain  numbered  only  7  out  of  13,  while  all  of  the  control 
cases  had  gained  except  2.  Of  the  test  group  8  cases  in  the 
second  period  either  gained  less  than  half  of  the  amount 
they  had  improved  in  the  first  period,  or  dropped  from  the 
scores  they  had  made  at  that  time.  The  corresponding  num- 
bers for  the  control  group  are  6  and  7. 

There  is  evidently  no  improvement  in  strength  of  grip 
twelve  months  after  operation.  The  unreliability  of  the  re- 
sults is  very  great.  However,  there  is  certainly  no  tendency 
toward  improvement.    Why  this  should  be  is  a  question.    It 


♦Numbers  refer  to  cases  as  listed  on  Table  II. 


62 


ADENOIDS  AND  DISEASED  TONSILS: 


may  be  that  the  change  in  examiners  is  partly  responsible, 
for  performance  in  this  test  is  influenced  to  a  surprising  ex- 
tent by  the  manner  in  which  it  is  presented. 

TABLE   XIX 
Tapping — Second  Retest,  15  Pairs 


N* 

Test  Group  (A] 

1 

Control  Group  (B) 

Testl 

Test  3 

Gain 

Testl 

Test  3 

Gain 

A-B 

21 

152 

154 

2 

149 

174 

34 

—32 

13 

160 

176 

16 

150 

188 

38 

—22 

1 

135 

142 

7 

106 

134 

28 

—21 

18 

133 

126 

-  7 

100 

108 

8 

—15 

23 

150 

157 

7 

122 

141 

19 

—12 

10 

68 

145 

77 

70 

148 

78 

—  1 

3 

136 

144 

8 

135 

135 

0 

8 

20 

105 

122 

17 

150 

154 

4 

13 

15 

172 

192 

20 

140 

145 

5 

15 

27 

108 

114 

6 

115 

101 

—14 

20 

8 

113 

128 

15 

131 

121 

—10 

25 

28 

150 

176 

26 

178 

172 

—  6 

32 

2 

105 

135 

30 

152 

139 

—13 

43 

11 

125 

120   - 

-  5 

155 

102 

—53 

48 

14 

190 

228 

38 

175 

165 

—10 

48 

Av. 

133.47 

150.6 

17.13 

134.6 

141.8 

7.2 

9.93 

M 

15 

4 

11 

75%ile 

21.5 

21.5 

26.75 

25%ile 

5 

—10.75 

—16.5 

Q 

8.25 

16.12 

21.62; 

P.  E. 

(distribution) 

10.13 

17.2 

22.07 

P.  E.  ( 

[average) 

±2.67 

±4.53 
Av.= 

±5.26 
1.89  P.  E. 
2.09  P.  E, 

There  were  15  pairs  of  cases  who  performed  the  tapping 
test  at  the  end  of  twelve  months.  Comparison  with  the  21 
pairs  after  six  months  yields  the  following  results: 

6  months  12  months 

Average  of  gains  of  test  group  in  excess  of  control  —  .09  9.93 

Median  of  gains  of  test  group  in  excess  of  control      0  11 

P.  E.  of  difference  ±3.10  ±5.26 

Average  in  terms  of  P.  E 03  1.89 

Median  in  terms  of  P.  E 0  2.09 

The  gain  in  the  second  interval  is  greater  for  the  tapping 
test  than  for  any  of  the  tests  yet  described.  After  the  first 
six  months  there  is  no  gain.  At  the  end  of  ten  months  the  av- 
erage gain  is  9.93,  and  the  median  11  taps  per  half  minute. 
After  six  months'  interval,  11  of  21  test  group  cases  had  lost. 
At  the  end  of  twelve  months,  only  2  out  of  15  had  lost.    The 


♦Numbers  refer  to  cases  as  listed  on  Table  II. 


THEIR  EFFECT  UPON  GENERAL  INTELLIGENCE 


63 


control  group,  on  the  other  hand,  lost  in  11  out  of  21  cases 
after  six  months,  and  in  6  out  of  15  at  the  end  of  twelve 
months.  All  but  one  of  the  test  group  cases  made  more  than 
half  of  their  gain  in  the  second  period.  Of  the  control  group 
only  7  cases  did  this.  The  variability  of  gains  after  12  months 
is  about  equal  to  the  variability  at  the  end  of  six  months. 

Strangely  enough,  decrease  in  f  atigueability  as  described 
in  the  previous  chapter  does  not  show  itself  after  12  months. 
In  fact,  the  negligible  loss  in  ability  noticeable  after  six 
months  has  increased  after  a  period  of  twelve  months.  In 
only  4  out  of  11  test  group  cases,  is  the  gain  in  the  second  peri- 
od equal  to  that  of  the  first,  a  similar  result  to  that  found  in 
the  control  group,  where  5  out  of  the  11  cases  made  half  their 
total  gain  in  the  second  interval.  The  results  are  compared 
below. 

6  months     12  months 

Average  of  gains  of  test  group  in  excess  of  control  —  .020  —  .06 

Median  of  gains  of  test  group  in  excess  of  control  —  .015  —  .09 

P.  E.  of  difference   ±  .04  ±   .036 

Average  in  terms  of  P.  E —  .50  — 1.66 

Median  in  terms  of  P.  E —  .38  —2.50 


TABLE  XX 
Tapping  for  Fatigue,  Second  Retests,  11  Pairs 


N* 

Test  Group  (A) 

Control  Group  (B) 

Testl 

Tests 

Gain 

Testl 

Tests 

Gain 

A-B 

20 

—.10 

.03 

—.13 

.20 

.0 

.20 

—.33 

27 

.15 

.17 

—.02 

.09 

—.17 

.26 

—.28 

10 

—.09 

.27 

—.36 

.06 

.16 

—.10 

—.26 

14 

.09 

.05 

.04 

.13 

-.13 

.26 

—.22 

13 

—.03 

—.06 

.03 

.27 

.07 

.20 

—.17 

28 

.01 

.05 

—.04 

.17 

.10 

.07 

—.11 

15 

.03 

.03 

.0 

.18 

.08 

.10 

—.10 

23 

.11 

.0 

.11 

.06 

.0 

.06 

.05 

21 

.27 

—.01 

.28 

.29 

.14 

.15 

.13 

11 

.28 

—.04 

.32 

.11 

—.01 

.12 

.20 

18 

.14 

—.15 

.29 

.01 

.15 

—.14 

.43 

Av. 

.078 

.031 

.047 

.143 

.035 

.107 

—.06 

M 

.03 

.12 

—.09 

75%ile 

.153 

.20 

.07 

25%ile 

—.062 

.02 

—  .275 

Q 

.107 

.09 

.172 

P.  E. 

(distribution) 

.087 

.093 

.19 

P.  E. 

(average) 

±.02 

±.03 
Av.=- 
M.=- 

±.036 
-1.66  P.  E. 
-2.50  P.  E. 

♦Numbers  refer  to  cases  as  listed  on  Table  II. 


64  ADENOIDS  AND  DISEASED  TONSILS: 

The  point  of  greatest  interest  in  the  present  study  is,  as 
has  been  said,  improvement  in  intelligence.  Does  operation 
for  adenoids  and  tonsils  result  in  improvement  in  intelligence, 
as  measured  by  I.  Q.  ?  If  such  improvement  does  not  manifest 
itself  after  six  months,  can  it  be  found  after  a  second  period  of 
the  same  length?  The  latter  question  is  answered  by  observa- 
tion of  Table  XXI  and  attention  to  the  following  facts,  gath- 
ered from  the  21  pairs  of  cases  who  were  given  intelligence 
tests  after  the  twelve  months'  interval.  i 

6  months     12  months 

Average  of  gains  of  test  group  in  excess  of  control  — 1.035  — 3.14 

Median  of  gains  of  test  group  in  excess  of  control  — 1  — 3 

P.   E.   of   difference    ±1.10  ±1.84 

Average  in  terms  of  P.  E —  .94  — 1.71 

Median  in  terms  of  P.  E —  .99  —1.63 

The  result  after  twelve  months  remains  the  same  as  that 
after  the  six  months'  interval.  A  gain  or  loss  of  two  or  three 
points  in  I.  Q.  is  negligible,  so  that  the  mean  gain  of  the  test 
group  in  excess  of  the  control  is  practically  zero  at  the  end 
of  each  period.  Variability  increases  with  the  length  of  the 
interval.  One  case  in  the  test  group  (case  4)  gained  nothing 
in  six  months,  but  showed  a  gain  of  15  points  after  13  months. 
However,  there  is  a  control  case  to  match  this, — case  15,  who 
gained  1  point  in  the  first  six  months  and  20  points  after  10 
months.  Case  20  in  the  test  group  lost  4  points  in  the  first 
six  months,  but  gained  back  these  and  10  additional  in  the 
second  period.  But  control  No.  1  gained  5  points  in  the  second 
interval  after  having  lost  4  in  the  first. 

On  the  other  hand  several  cases  lost  in  the  second  period, 
as  compared  with  the  first.  Test  group  case  7,  for  example, 
gained  8  points  in  the  first  six  months,  and  lost  6  of  them  in 
the  second.  Case  3  in  the  same  group  lost  3  points  in  the  first 
period,  and  failed  to  regain  any  of  them.  Case  12  lost  3  points 
in  six  months  and  9  more  before  the  end  of  12  months.  In  the 
control  group,  case  23  gained  15  pounds  in  the  first  six  months 
and  lost  eight  of  them  in  the  second.  Summing  up  gains  and 
losses  in  the  second  period,  for  both  groups: 


THEIR  EFFECT  UPON  GENERAL  INTELLIGENCE 
TABLE  XXI 


65 


I.  Q.. 

Second  Retests.  21 

Pairs 

N* 

Test  Group  (A) 

Control  Group  (B) 

Testl 

Tests 

Gain 

Testl 

Test  3 

Gain 

A— B 

27 

110 

112 

2 

72 

98 

26 

—24 

15 

97 

97 

0 

78 

98 

20 

—20 

3 

94 

91 

—  3 

82 

96 

14 

—17 

7 

91 

93 

2 

95 

112 

17 

—15 

20 

106 

116 

10 

118 

140 

22 

—12 

23 

85 

80 

—  5 

81 

88 

7 

—12 

8 

91 

92 

1 

98 

111 

13 

—12 

12 

98 

86 

—12 

98 

91 

—  7 

—  5 

21 

64 

66 

2 

86 

93 

7 

—  5 

4 

96 

111 

15 

83 

102 

19 

—  4 

13 

70 

61 

—  9 

66 

60 

—  6 

—  3 

18 

98 

101 

3 

90 

92 

2 

1 

16 

65 

74 

9 

74 

81 

7 

2 

10 

110 

116 

6 

104 

107 

3 

3 

28 

81 

83 

2 

95 

94 

—  1 

3 

11 

103 

102 

—  1 

101 

95 

—  6 

5 

1 

82 

93 

11 

80 

85 

5 

6 

14 

96 

102 

6 

140 

138 

—  2 

8 

19 

96 

97 

1 

98 

90 

—  8 

9 

2 

107 

113 

6 

91 

86 

—  5 

11 

9 

83 

102 

19 

87 

91 

4 

15 

Av. 

91.5 

94.6 

3.0 

91.2 

97.5 

6.2' 

—  3.1 

M 

2 

5 

—  3 

75%ile 

6 

13.75 

4.5 

25%ile 

—.75 

—  4.25 

—12 

Q 

3.37 

9.00 

8.25 

P.  E. 

(distribution) 

2.09 

8.24 

8.86 

P.  E. 

(average) 

±.45 

±1.79 

±1.84 

Av.=— 1.71  P.  E. 

M.=— ] 

L.63  P.  E. 

Test  group 
Control  group 


Lost  in  2nd  Gained  in  2nd       No       Gained  equally 
period  period         change      with  gain  in 

1st  period 
9  11  1  9 

10  11  8 


The  average  gain  of  the  test  group  was  3.09  points  after 
12  months,  compared  with  2.25  after  six.  The  control  group, 
however,  made  an  average  gain  of  6.24  after  12  months,  the 
gain  after  six  months  being  3.29.  These  numbers  are  insig- 
nificant as  gains,  but  they  at  least  show  no  improvement 
in  the  test  group  which  the  control  group  does  not  reveal  as 
well.  On  the  basis  of  the  results,  we  may  say  that  there  has 
been  no  improvement  in  I.  Q.  as  a  result  of  operation,  either 
after  six  months  or  after  twelve. 

There  remains  to  be  considered  only  the  result  of  the 
Healy  Picture  Completion  Test.  We  have  scores  in  this  test 
for  18  pairs  of  cases.  When  these  scores  are  compared  with 
those  in  the  former  tests,  the  results  stand  as  follows : 


*Nunibers  refer  to  cases  as  listed  on  Table  IL 


66 


ADENOIDS  AND  DISEASED  TONSILS: 


Average  of  gains  of  test  group   in  excess  of  control  — 5.85  — 3.36 

Median  of  gains  of  test  group  in  excess  of  control  — 7.75  1 

P.  E.  of  difference   ±3.05  ±3.38 

Average  in  terms  of  P.   E — 1.92  —  .87 

Median  in  terms  of  P.  E — 2.54  .26 

The  figures  given  above  show  no  gain  in  the  Healy  test  as 
a  result  of  operation.  Both  after  six  months,  and  after  twelve, 
we  find  that  the  test  group  has  gained  no  more  than  the  con- 
trol group.  As  before  there  are  individual  cases  showing  con- 
siderable gain  in  the  second  period,  but  these  are  matched  by 
control  cases  which  reveal  equal  or  even  greater  gains.  In  the 
test  group,  5  cases  lost  in  the  second  period  in  comparison 
with  the  first,  18  gained,  and  7  gained  as  much  in  the  second 
period  as  in  the  first.  The  control  group  lost  in  the  second 
period  in  5  cases,  gained  in  18,  and  gained  as  much  as  in  the 
first  period  in  7  cases.  The  two  groups,  then,  are  practically 
equal,  both  showing  a  gain  in  the  second  period,  but  this  gain 
cannot  be  due  to  the  operations,  since  the  control  group  did 
not  undergo  operation. 

TABLE  XXII 

Healy  A,  Second  Retests,  18  Pairs 

N*  Test  Group  (A)  Control  Group  (B) 

Testl         Tests        Gain  Test  1         Test  3      Gain  A— B 

12  20                1              —19  —10            41.5         51.5  —70.5 
23            49.5           62.5               13                    4            64            60  —47 

15  7  19  12  1  54.5         53.5       —41.5 

1  —22  11  36  —50  11  61  —25 

2  28.5  24.5  —  4  3  19.5         16.5       —20.5 

3  21.5  15.5  —  6  17  25.5  8.5       —14.5 

19  57.5  60.5  3  —22        —15  7  —  4 

13  43  62.5  19.5  —  1.5         21.5         23  —  3.5 
21            20              38                  18                  70.5         88            17.5  .5 

10  —12  11  23  27  48.5         21.5  1.5 

14  12.5  77  64.5  —  5  48.5         53.5  11 

27  —25  25.5  50.5  2            39.5  37.5  13 

11  —  8  15.5  23.5  —29  —20              9  14.5 

16  49  79  30  30            45.5  15.5  14.5 
7—6  16  22  45            11              6.5  15.5 

28  29.5  77.5               48  64.5         83.5         19  29 
18        —13.5  13.5               27  —32        —35        —  3  30 

20  0  55                  55  30            48.5         18.5  36.5 
Av.         13.81  36.92            23.11  5.77      32.25       26.47  —  3.36 
M                                                   22.5  18.75  1 
75%ile                                           33  44  14.5 
257cile                                             7.5  8.75  —22.25 
Q                                                    12.75  17.62  18.37 
P.  E.   (distribution)                 11.5  17.72  17.86 
P.  E.  (average)                      ±2.7  ±4.22  ±3.88 

Av.=ii—  .87  P.  E. 
M.  =4-  .26  P.  E. 

*Numbers  refer  to  cases  as  listed  on  Table  II. 


THEIR  EFFECT  UPON  GENERAL  INTELLIGENCE 
TABLE  XXIII 


67 


Weight 

in 

Height 

in 

Height 

-weight 

Grip  in 

Gains 

pounds 

inches 

J 

percents 

Kg. 

lb. 

P.E. 

in. 

P.E. 

% 

P.E. 

Kg.        P.  E. 

Av.  1 

1.37 

2.85 

.16 

1. 

1.83 

2.02 

—.24    —  .50 

Av.  2 

1.90 

1.30 

.08 

.29 

3.23 

2.81 

—1.31     —2.22 

M.   1 

1.20 

2.80 

.20 

1.25 

4.00 

4.40 

—1.00     —2.08 

M.  2 

2.20 

1.51 

.50 

1.79 

6.00 

5.22 

—1.50     —2.54 

P.  E.  1 

±  .48 

M;, 

16 

HK 

,91 

±.48 

P.  E.  2 

±1.46 

±, 

,28 

±l!l6 

±.59 

TABLE  XXIII  (Continued) 


Gains 

Taps 

in 

Tapping  in 

Yz  min. 

fatigue  ratios 

I.  Q. 

Healy  Score 

taps 

P.E. 

ratio         P.  E. 

Pts.       P.  E. 

Pts.        P.  E. 

Av.  1 

.09 

.03 

—.02      —  .50 

—1.035  —  .94 

—5.85     —  .92 

Av.  2 

9.93 

1.89 

—.065     —1.66 

—3.14     —1.71 

—3.36     —  .87 

M.  1 

0. 

0. 

—.015     —  .38 

—1.         —  .99 

—7.75     —2.54 

M.  2 

11. 

2.09 

—.09       —2.50 

—3.         —1.63 

1                .26 

P.  E.  1 

±3.10 

±.04 

±1.10 

±3.05 

P.E.  2 

±5.26 

±.036 

±1.84 

±3.88 

In  Table  XXIII  are  collected  the  results  discussed  in  the 
foregoing  chapter.  The  mean  results  are  expressed  in  terms 
of  P.  E.  and  as  gross  values,  so  that  the  various  tests  may  be 
compared. 


CHAPTER  V. 

SUMMARY 

The  results  obtained  from  the  experiment  may  be  summar- 
ized as  follows: 

1.  Six  months  after  operation  for  adenoids  and  tonsils, 
there  seems  to  be  a  slight  but  not  very  reliable  gain  in  weight 
as  the  result  of  the  operation.  After  twelve  months  this  has 
increased;  indeed,  it  has  very  nearly  doubled. 

2.  Gain  in  height,  resulting  from  operation,  is  so  slight 
as  to  be  unreliable.  This  gain  does  not  increase  during  a  sec- 
ond period  of  six  months. 

3.  The  height-weight-age  relationship  is  an  excellent 
measure  of  the  physical  well-being  of  the  child.  The  figures 
expressing  this  relationship  show  no  very  reliable  gain  in  the 
first  six  months,  but  improvement  increases  considerably  dur- 
ing the  second  period. 

4.  The  test  group  shows  no  gain  over  the  control  group 
in  strength  of  grip.  There  seems  on  the  other  hand  to  be  a 
slight  loss;  which  does  not  decrease  in  amount  during  the 
second  period. 

5.  Speed  of  tapping  did  not  increase  during  the  first  peri- 
od, any  more  for  the  test  group  than  for  the  control.  During 
the  second  period,  however,  there  is  a  marked  improvement. 

6.  Operation  for  adenoids  and  tonsils  does  not  lessen  fa- 
tigueability  as  shown  by  the  tapping  test.  The  probability  is, 
however,  that  the  test   is  at  fault. 

7.  No  rise  in  I.  Q.,  as  a  result  of  operation,  makes  itself 
evident  after  six  months  or  after  twelve  months. 

8.  There  is  no  improvement  in  the  performance  of  the 
Healy  test  either  after  six  months  or  after  twelve. 

9.  In  every  test  except  grip  and  tapping,  there  is  a  marked 
increase  in  the  variability  of  the  gains  after  the  second  period. 
This  is  possibly  due  simply  to  the  fact  that  the  longer  interval 

68 


THEIR  EFFECT  UPON  GENERAL  INTELLIGENCE  69 

permits  the  intervention  of  more  extraneous  factors  which 
may  influence  the  scores  in  one  direction  or  the  other. 

10.  A  group  of  236  children  with  diseased  tonsils  showed 
equal  distribution  of  I.  Q.  with  a  group  of  294  children  who 
were  normal  in  this  respect. 

CONCLUSIONS 

The  article  by  MacPhail,  which  has  been  reviewed  in  a 
former  chapter,  showed  pretty  conclusively  that  the  removal 
of  adenoids  and  tonsils  was  followed  by  improvement  in  school 
work.  That  such  improvement  was  not  due  to  a  rise  in  gener- 
al intelligence  can  be  concluded  from  the  present  experiment. 
That  efficiency  in  school  work  does  not  rest  wholly  upon  in- 
telligence has  been  demonstrated  more  than  once.  The  ten- 
dency here  noted  to  improve  in  general  physical  tone  may,  per- 
haps, serve  as  a  sign  of  the  factor  upon  which  such  improve- 
ment depends.  Improved  health  means  better  attention,  bet- 
ter emotional  response,  greater  resistance  to  fatigue,  and 
probably  increased  efficiency. 

Interesting  investigations  of  such  improvement  in  efficien- 
cy might  be  made  by  administering  educational  tests  to  groups 
similar  to  those  of  the  present  study.  The  results  of  such  an 
experiment  would  be  exceedingly  instructive,  and  would  be 
more  significant  than  conclusions  drawn  from  school  marks. 
By  this  means  also  we  might  determine  along  what  special 
line  efficiency  is  most  affected. 

Since  there  was  no  recuperation  in  intelligence  resulting 
from  operation  for  adenoids  and  tonsils,  it  is  reasonable  to 
expect  that  there  had  been  no  retardation  from  which  to  re- 
cuperate. This  supposition  is  borne  out  by  results  of  the  sta- 
tistical study,  wherein  we  found  that  a  group  of  children  suf- 
fering from  diseased  tonsils  possessed  equal  intelligence  with 
a  group  which  was  free  from  such  defect. 

We  can  say  to  physicians,  then,  with  fair  amount  of  assur- 
ance, that  removal  of  adenoids  and  tonsils  will  probably  not 
raise  to  any  great  degree  the  intelligence  level  of  the  mentally 
defective  child  who  is  brought  to  him.  We  can  say  to  students 
of  the  constancy  of  the  I.  Q.,  that  it  is  not  greatly  lowered  by 
adenoids  and  diseased  tonsils  and  we  may  say  to  the  clinical 
psychologist  that  these  defects  have  no  demonstrable  effect 
upon  general  intelligence,  whatever  effects  they  may  have  on 


70  AD£!NdlDS  AND  DISEASED  TONSILS: 

volitional  and  emotional  normality, — ^the  two  elements  which, 
along  with  intelligence  are  necessary  for  the  maintenance 
of  the  individual  as  an  instrument  of  social  efficiency. 


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